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31.
ObjectivesTo examine the impact of time to surgery (TTS) on survival among patients with stage I non-small cell lung cancer (NSCLC).MethodsAll patients in the Canadian province of Ontario with stage I NSCLC from 2007 to 2017 were included. A logistic regression identified the predictors of TTS and a flexible parametric model estimated survival rates based on TTS.ResultsOver the study period, 6428 patients with stage I NSCLC undergoing surgical resection were identified, of which 62.5% had TTS >28 days. Less than half these patients (40.8%) underwent open resection, with 19.3% undergoing open sublobar and 21.5% undergoing open lobectomy. Adenocarcinoma and squamous cell carcinoma tumors accounted for 33.3% and 22.0% of cases, respectively. The majority (85.6%) of patients lived in urban areas within 50 km of a regional cancer center (76.9%). Variables that predicted TTS >28 days include age and extent of resection. After adjustment for VATS vs. open resection, age, sex, frailty, year of diagnosis, histology of tumor, and extent of resection, the hazard ratio for TTS >28 days was 1.26 (95%CI:1.13–1.40), indicating a 26% increased risk of all-cause mortality (p < 0.0001). The highest 5-year survival was observed for patients with stage I disease undergoing resection within 28 days.ConclusionsThe present study found age and extent of resection to be associated with increased TTS. Importantly, patients with TTS >28 days had reduced long-term survival. 相似文献
32.
关菁 《中国实用妇科与产科杂志》2022,38(11):1083-1088
输卵管因素不孕症占不孕人群的30%~35%。随着腹腔镜技术及微创手术原则的应用,生殖相关输卵管性疾病的微创手术治疗受到关注。手术治疗输卵管性不孕在评估输卵管功能,保留生育功能,改善患者自然妊娠或辅助生殖技术助孕的结局方面具有重要作用。文章主要对有生育要求的输卵管病变患者,腹腔镜手术保留及恢复生育功能的处理及临床结局进行阐述。 相似文献
33.
背景 既往对肝癌微血管侵犯病理诊断的重要性重视不够,目前国内外缺乏对微血管侵犯统一的病理诊断标准,也未将微血管侵犯列为病理常规诊断指标。C反应蛋白/白蛋白比值(CAR)作为新型系统性炎性因子,与肝癌的增殖、侵袭转移等恶性生物学行为密切相关。 目的 探讨CAR预测单发小肝癌患者微血管侵犯的价值。 方法 选择2017年6月至2021年6月在新疆医科大学第一附属医院行肝切除术的单个、肿瘤直径≤5 cm的术后病理检查证实为肝癌的患者346例为研究对象。收集患者一般资料,并计算CAR。绘制CAR预测单发小肝癌患者微血管侵犯的受试者工作特征(ROC)曲线,并计算CAR的最佳诊断截点,根据CAR最佳诊断截点将患者进行分组,采用1∶1最近邻居倾向性评分匹配(PSM)法将Logistic模型估计的倾向性评分相近患者进行配对,得到两组间各临床特征比较均衡性较高的样本。比较匹配后两组患者微血管侵犯率,采用Logistic回归分析评估匹配前、后CAR对单发小肝癌患者微血管侵犯的预测价值。 结果 346例患者中微血管侵犯阳性131例(37.9%),微血管侵犯阴性215例(62.1%)。ROC曲线分析结果显示,CAR预测单发小肝癌患者微血管侵犯的灵敏度为82.9%,特异度为76.4%,ROC曲线下面积为0.787〔95%CI(0.697,0.877)〕,最佳诊断截点为0.03。根据CAR最佳诊断截点,将患者分为CAR<0.03组(A组,n=145)和CAR≥0.03组(B组,n=201)。采用1∶1最近邻居PSM法,共92对匹配成功,匹配后两组临床资料均衡。匹配后,B组患者微血管侵犯发生率〔43.5%(40/92)〕高于A组〔13.0%(12/92)〕(χ2=6.314,P=0.013)。采用3种Logistic回归分析结果显示,匹配前、后CAR均为单发小肝癌患者微血管侵犯的独立影响因素(P<0.05)。 结论 CAR作为新型系统性炎症指标,可用于预测单发小肝癌微血管侵犯,当CAR≥0.03时提示单发小肝癌微血管侵犯发生率较高。 相似文献
34.
《The Journal for Nurse Practitioners》2022,18(10):1048-1051
On June 24, 2022, the Supreme Court of the United States ruled to strike down Roe v. Wade (1973), a landmark decision that legalized access to abortion under the right to privacy. By overturning Roe, the decision now leaves the regulation of abortion up to each individual state. Consideration of the consequences that will affect vulnerable populations is paramount now that Roe v. Wade is overturned. Nurse practitioners who are impartial toward abortion should be introduced to Reproductive Justice, which can help them better understand the lived experiences of people with the capacity for pregnancy and the complexities surrounding abortion. 相似文献
35.
36.
Tryntsje Fokkema Robert Burggraaff Fred Hartgens Bas Kluitenberg Evert Verhagen Frank J.G. Backx Henk van der Worp Sita M.A. Bierma-Zeinstra Bart W. Koes Marienke van Middelkoop 《Journal of Science and Medicine in Sport》2019,22(3):259-263
Objectives
To investigate the prognosis and possible prognostic factors of running-related injuries (RRIs) in novice runners.Design
Prospective cohort study.Methods
Participants of Start to Run, a 6-weeks course for novice runners in The Netherlands, were asked to participate in this study. Before the start of the course a baseline questionnaire, on demographics, physical activity and perceived health, was sent to runners willing to participate. The 26- or 52-weeks follow-up questionnaires assessed information on RRIs and their duration. Only participants that sustained a RRI during follow-up were included in the analyses. An injury duration of 10 weeks or shorter was regarded as a relatively good prognosis, while an injury duration of more than 10 weeks was defined as a poor prognosis. To determine the associations between baseline characteristics and injury prognosis and between injury location and injury prognosis, multivariable logistic regression analyses were performed.Results
347 participants (48.8%) sustained an RRI during follow-up. The RRIs had an overall median duration of eight weeks (range: 1–52 weeks). Participants with a previous RRI were more likely to have a poor prognosis (OR 2.31; 95%CI 1.12–4.79), while a calf injury showed a trend towards an association with a relatively good prognosis (OR 0.49; 95%CI 0.22–1.11).Conclusions
The duration of RRIs in novice runners is relatively long, with only calf injuries being associated with a good prognosis. This emphasizes the need of injury prevention measures in novice runners and adequate support during and after an RRI, especially in runners with a previous injury. 相似文献37.
Yassir Turki Suha Saleh Shatha Albaik Yasmeen Barham Dorien van de Vrie Yousef Shahin Majed Hababeh Akihiro Seita 《Lancet》2019
Background
Mental health is a major public health priority, particularly among refugees worldwide. The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) started to integrate mental health and psychosocial support (MHPSS) into its primary health-care services in Jordan in late 2017. This baseline study aimed to assess the knowledge, attitudes, practices, and perceived barriers among UNRWA health staff regarding the implementation of the MHPSS programme.Methods
The UNRWA Health Programme conducted a cross-sectional study of a sample of 220 out of the 390 male and female doctors, dentists, nurses, and midwives who work at 16 of the 25 UNRWA health centres in Jordan during November, 2017. Individuals on duty at the health centres on the day of the survey were included. The 16 health centres were selected based on their size and accessibility to surveyors (reflecting proximity to Amman, and the size of population served). Of the selected health centres, seven were large, seven were medium, and two were small according to the UNRWA classification of health centres (based on the number of medical doctors). A validated self-administered questionnaire was used. Ethics approval was granted by the UNRWA Health Programme ethics committee, and informed written consent was obtained from all participants. Data analysis was performed using SPSS (version 22).Findings
Of the participants, 73% (161 of 220) believed that their knowledge of MHPSS programmes was insufficient, with no significant difference (p=0·116) between different categories of staff. Furthermore, 88% (194 of 220) said that they needed more training, 67% (147 of 220) reported that the number of mental health cases is increasing, and 50% (110 of 220) that dealing with these cases is difficult. Reflecting on the past 12 months, 31% of staff (69 out of 220) reported meeting between one and ten children, and 45% (100 out of 220) reported meeting between one and ten adults suspected of having mental illnesses. The most suspected condition was depression (84%; 150 of 220), followed by epilepsy (64%; 140 of 220). The main perceived barriers to implementation included the limited availability of MHPSS policies (87%; 192 of 220), MH professionals (86%; 190 of 220), resources (86%; 189 out of 220), and lack of privacy (14%; 31 out of 220).Interpretation
Most health staff had positive attitudes towards MHPSS programme implementation but felt they lacked the required knowledge. There is a need for training and clear technical guidelines. Perceived barriers to MHPSS programme implementation need to be tackled with a structured plan of action.Funding
The UNRWA Health Programme, UNRWA Headquarters, Amman, Jordan. 相似文献38.
俞海燕 《浙江中西医结合杂志》2019,29(10)
<正>机体的血钾参与并维持细胞代谢,保持细胞内液渗透压及酸碱平衡,并可维持神经肌肉组织兴奋及心肌功能~([1-2])。中重度低血钾主要表现为肌无力,可延及机体的躯干和呼吸肌,造成呼吸困难,还可引发腱反射减弱或消失、肠麻痹及心脏传导阻滞、节律异 相似文献
39.
Objectives
To identify barriers to postpartum permanent contraception procedures after vaginal delivery and to explore contraceptive and reproductive outcomes of women who experience unfulfilled requests.Study design
We performed a retrospective cohort study of women requesting postpartum permanent contraception after vaginal delivery from 7/1/11 to 6/30/14 at Strong Memorial Hospital in Rochester, NY. We ascertained patient characteristics and outcomes through electronic medical records and birth certificate data search.Results
Of 189 women in our sample, 78 (41.3%) had a postpartum permanent contraception procedure. Factors associated with unfulfilled requests in adjusted analysis included BMI ≥40 (OR 3.71, 95% CI 1.46–9.48 compared to BMI <35), federal sterilization consent signed ≥36 weeks (OR 5.10, 95% CI 1.64–15.86 compared to <36 weeks) and delivery in the latter half of the week (Wednesday–Saturday) (OR 2.02, 95% CI 1.08–3.79). Documented reasons for unfulfilled permanent contraception requests included patient changing her mind related to procedural issues (21, 18.9%), invalid consent (20, 18.0%), maternal obesity (17, 15.3%), lack of operating room availability (14, 12.6%) and ambivalence about permanent contraception (5, 4.5%). Of 57 women who planned for interval permanent contraception and had institutional follow-up over the subsequent year, 14 (24.6%) had a procedure, 8 (14.0%) initiated long-acting reversible contraception, and 13 (22.8%) became pregnant.Conclusions
Fewer than half of women obtained desired postpartum permanent contraception after vaginal delivery, with logistical issues and obesity being the most common reported barriers. Health care providers should advocate for access to postpartum permanent contraception, as well as discuss prenatally the individualized probability of nonfulfillment and importance of alternative contraceptive plans.Implications
Logistical barriers and inappropriate antenatal preparation contribute to the fact that over half of women do not obtain desired postpartum permanent contraception after vaginal delivery. To respect reproductive autonomy and improve care, clinicians and other health officials should eliminate barriers to immediate postpartum permanent contraception while increasing access to alternative options. 相似文献40.
Luke D. Kim Elizabeth R. Pfoh Bo Hu Lei Kou Lisa M. Knowlton Kristan Staudenmayer Michael B. Rothberg 《Journal of the American Medical Directors Association》2019,20(9):1086-1090.e2
ObjectivesTo identify factors associated with 30-day all-cause readmission rates in surgical patients discharged to skilled nursing facilities (SNFs), and derive and validate a risk score.DesignRetrospective cohort.Setting and participantsPatients admitted to 1 tertiary hospital's surgical services between January 1, 2011, and December 31, 2014 and subsequently discharged to 110 SNFs within a 25-mile radius of the hospital. The first 2 years were used for the derivation set and the last 2 for validation.MethodsData were collected on 30-day all cause readmissions, patient demographics, procedure and surgical service, comorbidities, laboratory tests, and prior health care utilization. Multivariate regression was used to identify risk factors for readmission.ResultsDuring the study period, 2405 surgical patients were discharged to 110 SNFs, and 519 (21.6%) of these patients experienced readmission within 30 days. In a multivariable regression model, hospital length of stay [odds ratio (OR) per day: 1.03, 95% confidence interval (CI) 1.02-1.04], number of hospitalizations in past year (OR 1.24 per hospitalization, 95% CI 1.18-1.31), nonelective surgery (OR 1.33, 95% CI 1.18-1.65), low-risk service (orthopedic/spine service) (OR 0.32, 95% CI 0.25-0.42), and intermediate-risk service (cardiothoracic surgery/urology/gynecology/ear, nose, throat) (OR 0.69, 95% CI 0.53-0.88) were associated with all-cause readmissions. The model had a C index of 0.71 in the validation set. Using the following risk score [0.8 × (hospital length of stay) + 7 × (number of hospitalizations in past year) +10 for nonelective surgery, +36 for high-risk surgery, and +20 for intermediate-risk surgery], a score of >40 identified patients at high risk of 30-day readmission (35.8% vs 12.6%, P < .001).Conclusions/ImplicationsAmong surgical patients discharged to an SNF, a simple risk score with 4 parameters can accurately predict the risk of 30-day readmission. 相似文献