Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry

BackgroundAdherence to follow-up visits is often unsatisfactory after bariatric surgery.ObjectivesTo identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion.SettingMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015–2018).MethodsPatients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45–60, and >60 years).ResultsPatients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m². More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non–insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (P_s < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (P_s < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45–60 years, respectively.ConclusionAlthough challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.     

Mindfulness Intervention on Adolescents’ Emotional Intelligence and Psychological Capital during the COVID-19 Pandemic: A Randomized Controlled Trial

Background: Since the outbreak of COVID-19 caused adults suffer from mental disorders, it would be an essential for psychologist to help individuals overcome mental disorders. Objective: This study aim to explore whether the intervention of mindfulness is an efficient method to enhance adolescents’ emotional intelligence (EI) and psychological capital (PC) to provide a theoretical basis and future directions for both targeted crisis intervention and psychological trauma recovery plans. Design: This research was designed as randomized controlled trial and total of 798 students were evaluated statistically. Methods: We used paired-sample t-tests and repeated measures ANOVA to compare every factor defined above by time and group. Then, we used Mplus to build LGCM to examine the trajectory of changes in EI and PC in the experimental group. Results and Conclusions: (1) The EI and PC scores had significantly different time points in the experimental group but not in the control group. (2) EI and PC tended to increase with intervention, and there were significant individual differences in the initial level and development speed. (3) Individuals’ EI could promote the growth of PC. This research indicated that mindfulness should be given increasing consideration to enhance mental health during the worldwide outbreak of COVID-19.     

儿童结肠镜术前肠道准备质量的影响因素

目的评估行结肠镜检查术前患儿的肠道准备质量,并探讨其影响因素。方法前瞻性纳入2017年8月1日至2018年3月31日期间行结肠镜检查术的患儿198例。根据Boston肠道准备评分量表(The Boston Bowel Preparation Scale,BBPS)进行肠道准备质量评价,并收集患儿一般资料、肠道准备过程相关情况;采用有序logistic回归分析肠道准备质量的影响因素。结果纳入的198例患儿中,男116例、女82例;平均年龄(8.70±2.87)岁;总BBPS得分为(7.45±1.31)分。肠道准备清洁程度为优104例(52.5%),良74例(37.4%),差20例(10.1%);发生不良反应90例(45.5%)。清洁度优、良、差三组患儿之间便秘史,服药后大便次数,最后一次大便性状,不良反应,服药前、服药期间、服药后运动的差异均有统计学意义(P0.05)。Logistic回归分析发现服药后大便次数少,最后一次大便性状为稀糊状、深黄色或褐色有渣、淡黄水样,服用泻药期间无运动和没有完全服用泻药是降低肠道准备清洁度的独立影响因素(P0.05)。结论临床应早期识别影响肠道准备质量的相关因素,并及时采取相应干预措施,以提高肠道准备质量。     

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目的 探讨机用PathfileTM镍钛锉联合手用ProTaper镍钛器械在磨牙狭窄根管的预备效果。方法 选择2011年8月至2012年2月广州市天河区人民医院口腔科门诊需行根管治疗的磨牙根管狭窄患者125例(患牙125颗),采用PathfileTM镍钛锉进行根管预处理,以手用Pro Taper镍钛器械完成根管预备,侧向加压技术充填根管,根据治疗前后的X线片评价根管预备和充填效果。结果 125颗患牙的419个根管中,409个形态好,7个未能完全疏通,无台阶、根尖堵塞、根管偏移及侧壁穿孔等并发症发生,有3根器械折断于根尖段。恰填403个根管,10个根管因未完全疏通、无法到达根尖孔或断针而欠填,6个根管超填。结论 采用机用PathfileTM镍钛锉疏通狭窄根管的根尖段后再以手用ProTaper镍钛器械完成根管预备,可获得良好的成形效果且较少出现并发症。     

二氢杨梅素固体分散体的制备及其体内药动学研究

目的制备二氢杨梅素固体分散体,并研究其体内药动学。方法以PVP K30为载体,溶剂挥发法制备固体分散体,考察其溶解度和体外溶出。18只大鼠随机分为3组,分别灌胃给予原料药、物理混合物、固体分散体0.5%CMC-Na混悬液(150 mg/kg),于0.167、0.25、0.5、0.75、1、2、4、6、8、12 h取血,HPLC法测定血药浓度,计算主要药动学参数。结果二氢杨梅素制成固体分散体后以无定型状态存在,其表观溶解度提高了9.8倍,累积溶出度增加。与原料药、物理混合物比较,固体分散体tmax缩短(P<0.05),Cmax、AUC0~t、AUC0~∞升高(P<0.05,P<0.01),生物利用度提高了2.66倍。结论固体分散体技术可明显促进二氢杨梅素体内吸收,提高其生物利用度。     

Reducing low value services in surgical inpatients in Taiwan: Does diagnosis-related group payment work?

Reducing low-value care is a top priority in health care. However, how prospective payment methods such as diagnosis-related group (DRG) payment scheme reduce the use of low-value services is unclear. This study aimed to assess frequency of low-value preoperative testing services among surgical inpatients over time and to investigate whether the 2010 Tw-DRG policy has reduced utilization of these services under the National Health Insurance program in Taiwan. The nationwide National Health Insurance claims data in Taiwan from 2008 to 2013 were used. The difference-in-differences (DID) method was adopted. Utilization of three low-value preoperative testing services (chest x-ray, echocardiogram, and stress testing) were assessed. The prevalence of the three preoperative tests ranged from 0.13 per 100 admissions (preoperative stress testing) to 78.12 per 100 admissions (preoperative chest x-ray). Following the implementation of the Tw-DRG policy, the predicted probability of low-value care use was significantly reduced from 67.91% to 64.93% in the DRG group but remained relatively stable in the comparison group (from 69.44% to 68.43%) in 2010. The use of three selected preoperative tests had only a minor temporary reduction in 2010, but later increased over time. The 2010 Tw-DRG policy did not significantly moderate the growth of low-value preoperative use. Hospital financial incentives alone may be insufficient for reducing the provision of low-value care.     

应用专科护理质量指标管理提高结肠镜诊疗病人肠道准备的合格率

[目的]探讨专科护理质量指标管理在提高结肠镜诊疗病人肠道准备合格率的作用。[方法]选取2018年3月-2018年6月行结肠镜检查的341例病人为对照组,实施常规肠道准备,2018年7月-2018年10月行结肠镜检查的401例病人为观察组,运用专科护理质量指标进行管理,落实包括建立标准饮食单、规范的泻药服用及方法、分时段健康教育及图片式粪便观察等护理措施及相应质控查检表等相关内容,比较两组病人肠道准备合格率及耐受度。[结果]观察组较对照组病人的肠道准备合格率及耐受度均有明显提高,差异有统计学意义(P<0.01)。[结论]应用专科护理质量指标管理,显著提高了病人肠道准备的合格率及病人的耐受度,体现了标准化肠道准备过程中人性化关怀,同时提升了专科护理质量及护士的专科综合能力。     

Cleaning,Shaping, and Disinfecting Abilities of 2 Instrument Systems as Evaluated by a Correlative Micro–computed Tomographic and Histobacteriologic Approach

IntroductionThis study assessed the cleaning, shaping, and disinfection abilities of 2 instrumentation systems in molar root canals using a novel correlative analytical approach.MethodsThe root canals from extracted mandibular and maxillary molars with apical periodontitis were pair matched according to anatomic similarities as determined by micro–computed tomographic analysis and prepared with either XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland) (n = 16) or Reciproc Blue (VDW, Munich, Germany) (n = 16) instruments and 2.5% sodium hypochlorite irrigation. Pre- and postpreparation micro–computed tomographic scans were used to identify and calculate the unprepared surface areas (shaping), which were histobacteriologically evaluated for the presence of residual bacteria (disinfection) and pulp tissue remnants (cleaning) in each canal third.ResultsUnprepared canal surface areas for XP-endo Shaper and Reciproc Blue in the full canal length were approximately 26% and 19% (P < .05), respectively (30% and 23% in the apical part of the canal, P > .05). Preparation with Reciproc Blue resulted in 37.5% canals free of bacteria in all sections examined and 56% in the apical sections only. XP-endo Shaper resulted in 44% canals free of bacteria in all sections, and 56% in the apical part of the canal only. Pulp tissue remnants were not observed in 31% (all canal sections) and 50% (apical canal sections) of specimens from both instrument systems. No significant differences were observed between instruments when comparing the amount of pulp tissue remnants and the number of cases negative for bacteria and tissue remnants (P > .05).ConclusionsAlthough the Reciproc Blue instrument had superior shaping ability in comparison with XP-endo Shaper, both systems performed similarly in cleaning and disinfecting root canals. Irregular canals and difficult-to-reach areas were not thoroughly cleaned and disinfected by any of the tested systems.