Endovascular management of spontaneous delayed migration of the flow-diverter stent

Background and purposeSpontaneous delayed migration of the flow-diverter stent (FD) is an unusual complication that can be fatal. The purpose of this study is to report our experience and review the literature for the management of delayed FD migration.Materials and methodsBetween November 2013 and June 2017, 122 patients treated by FD at our institution were enrolled. We also performed a comprehensive review of the literature.ResultsSix patients (4.9%) were found to have spontaneous delayed migration of their FD. The device migrated proximally in 4 patients and distally in 2 patients. One patient had temporal lobe infarction due to stent migration, and another had subarachnoid haemorrhage (SAH). Three patients were treated with a 2nd or 3rd FD, while 2 were treated with stent-assisted coiling, and one was treated with sacrifice of the parent internal carotid artery. According to our results and the literature, the prevalence rate of delayed FD migration ranges from 2.2% to 4.9%, and the mortality and morbidity rate of delayed FD migration is 40%.ConclusionsNeuro-interventionalists should be aware of this complication and be familiar with risk factors, preventive methods and treatment options. If there is any concern regarding the size or position of the FD, early imaging follow-up and endovascular treatment should be indicated.     

问题导向干预对卵巢癌患者应对方式及心理弹性的影响

目的探讨问题导向干预对卵巢癌患者应对方式及心理弹性的影响。方法选取96例卵巢癌患者,随机分为两组各48例,对照组行常规护理,观察组在对照组基础上行问题导向护理干预,比较两组的应对方式和心理弹性。结果干预后,观察组的面对评分显著高于对照组,屈服和回避评分显著低于对照组,心理弹性各项目评分均显著高于对照组(P<0.05)。结论问题导向干预能有效缓解卵巢癌患者的负面情绪,增加积极应对方式,提升心理弹性,促进患者转归。     

评教评学模式在肿瘤外科护理带教中的应用评价

目的探讨评教评学模式在肿瘤外科护理带教中的应用效果。方法选择2017年6月—2019年2月于该院肿瘤外科实习的88名护生作为该次研究对象,随机将护生分为对照组与观察组,两组分别有护生44名,对照组给予传统带教方法,观察组给予评教评学模式带教,比较两组护生的护理带教结果。结果观察组护生对带教老师综合能力评价优良率是92.0%,对照组评价优良率是76.0%,组间对比差异有统计学意义(χ^2=4.192,P=0.041<0.05)。观察组带教老师对护生综合能力评价优良率是90.9%,对照组评价优良率是72.7%,组间对比差异有统计学意义(χ^2=4.889,P=0.027<0.05)。观察组护生的理论知识与实操技能考核成绩均要显著比对照组高,差异有统计学意义(P<0.05)。结论评教评学模式在肿瘤外科护理带教中具有显著应用价值,可充分激发师生的教学积极性,改善护理教学质量。     

运用全面质量管理构建血管神经病学高级人才管理平台

目的 运用信息化建设对血管神经病学高级人才进行系统化管理，在培养人才的基础上，提高人 才管理质量和效益。 方法 以首都医科大学附属北京天坛医院血管神经病学科为例，运用全面质量管理对高级人才进 行规范化管理，同时建立医院人才网络管理平台，实现数据共享，为信息积累和分析提供依据。 结果 在质量管理的基础上，理顺了业务流程，建立了多元化的人才培养机制，搭建了医院高级人 才网络管理平台，实现动态业务管理。 结论 医院在对血管神经病学高级人才进行质量管理中，体现了全面性和合理性，实现医院关于高 级人才的现代化、科学化、可持续化管理。     

责任制带教模式在重症监护室实习护生带教中的效果观察

目的研究分析在重症监护室实习护生的带教工作中采用责任制带教模式管理的效果。方法随机抽选2018年1-8月在该院重症监护室实习的护生资料共计56名开展对照分析,抽签法分组为观察组以及对照组,每组28名。对照组实习护生接受功能制教学模式带教,观察组实习护生接受责任制带教模式,分析两组实习护生的理论考核、病历书写、护患沟通、规范操作以及平均成绩分数差异。结果观察组中实习护士的理论考核、病历书写、护患沟通、规范操作以及平均成绩分数均显著高于对照组(P<0.05)。结论在医院重症监护室的带教工作中,针对实习护生采取责任制带教模式有利于提升其理论水平以及实践操作能力,进而显著提升护理教学质量,具有较高的临床推广价值。     

Ensayo clínico para determinar si el momento de administración del ácido tranexámico en la cirugía de prótesis total de rodilla con torniquete influye en el sangrado perioperatorio

Background and objectivesThe ideal timing of tranexamic acid administration in total knee arthroplasty with tourniquet remains unclear. Our primary objective was to prove if administering it before surgical incision, instead of before releasing the tourniquet, reduces postoperative bleeding. A second objective was to determine whether a second dose reduces post-operative bleeding.Material and methodsA prospective, double-blind clinical trial was performed on 212 patients scheduled for total knee arthroplasty. They were randomised into 4 groups. Tranexamic acid was administered before the surgical incision in “pre-induction groups” (1 and 2), and just before the tourniquet release in “pre-release groups” (3 and 4). Groups 2 and 4 received a second dose 3 hours post-surgery. Main outcome was postoperative bleeding (visible blood loss and calculated total bleeding). Secondary outcomes were haemoglobin variations, complications and transfusion rate.ResultsThe mean calculated total bleeding was 1563 ml (95%CI: 1445 to 1681) in preinduction groups versus 1576 ml (95%CI: 1439 to 1713) in pre-release groups (P = .9); 1579 ml (95%CI: 1452 to 1706) in single-dose groups versus 1559 ml (95%CI: 1431 to 1686) in double-dose groups (P = .82). One patient was transfused. The mean haemoglobin at discharge was 10.4 g/dl (95%CI: 10.2 to 10.7) in singledose groups versus 10.8 (95%CI: 10.6 to 11.1) in double-dose groups (P = .06).ConclusionsThere were no differences in bleeding or transfusion regarding the time of tranexamic acid administration. The second dose had not impact on outcomes.Trial registration: EudraCT 2016-000071-24.     

Application of the adverse outcome pathway framework to genotoxic modes of action

In May 2017, the Health and Environmental Sciences Institute's Genetic Toxicology Technical Committee hosted a workshop to discuss whether mode of action (MOA) investigation is enhanced through the application of the adverse outcome pathway (AOP) framework. As AOPs are a relatively new approach in genetic toxicology, this report describes how AOPs could be harnessed to advance MOA analysis of genotoxicity pathways using five example case studies. Each of these genetic toxicology AOPs proposed for further development includes the relevant molecular initiating events, key events, and adverse outcomes (AOs), identification and/or further development of the appropriate assays to link an agent to these events, and discussion regarding the biological plausibility of the proposed AOP. A key difference between these proposed genetic toxicology AOPs versus traditional AOPs is that the AO is a genetic toxicology endpoint of potential significance in risk characterization, in contrast to an adverse state of an organism or a population. The first two detailed case studies describe provisional AOPs for aurora kinase inhibition and tubulin binding, leading to the common AO of aneuploidy. The remaining three case studies highlight provisional AOPs that lead to chromosome breakage or mutation via indirect DNA interaction (inhibition of topoisomerase II, production of cellular reactive oxygen species, and inhibition of DNA synthesis). These case studies serve as starting points for genotoxicity AOPs that could ultimately be published and utilized by the broader toxicology community and illustrate the practical considerations and evidence required to formalize such AOPs so that they may be applied to genetic toxicity evaluation schemes. Environ. Mol. Mutagen. 61:114–134, 2020. © 2019 Wiley Periodicals, Inc.     

时效激励结合绩效考核管理模式在内分泌科护士管理中的应用研究

目的 探讨时效激励结合绩效考核管理模式在内分泌科护士管理中的应用效果。方法 选取2017年10月-2018年10月我院36名内分泌科护士为研究对象。比较实施时效激励结合绩效考核管理模式前后,病区护理质量和护士工作倦怠情况。结果 实施后,护士的情感枯竭、去人格化倾向评分均低于实施前(t=8.613,P=0.029; t=5.495,P=0.020),而个人成就评分高于实施前(t=3.626,P=0.031);护理工作质量评价量表各维度评分均高于实施前。结论 时效激励结合绩效考核管理模式可有效缓解内分泌科护士的工作倦怠感,提高护理质量,值得临床推广应用。     

某院注射剂避光药品管理的探索与实践

该文对某医院的注射剂避光药品管理进行研究,在该次研究中发现,某医院共有药品1 500多种,其中,避光注射剂的种类就达到了248种。由此可以看出,在医院的药品之中,避光注射剂的有着比较多的种类和数量。应该不断强化对注射剂避光药品的管理,这样才可以让这一类的注射剂发挥出其原有的作用,有效避免因避光不佳而导致的药物失效甚至一些临床不良反应的情况出现。