Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review

Purpose

This purpose of this systematic review was to determine the safety and efficacy of arterial embolization as the primary treatment for grade III-V liver trauma, excluding the postoperative use of arterial embolization.

Ischemic Stroke: Management by the Nurse Practitioner

Approximately 800,000 people living in the United States are diagnosed with a stroke each year. Nurse practitioners are positioned to impact and improve stroke survivor’s outcomes in the primary and acute care setting. This article provides an overview of stroke management pre- and postdischarge in the primary care setting and addresses acute stroke treatment during hospitalization.     

职业病网络报告系统用户权限管理现状及对策

目的分析职业病网络报告系统用户权限管理现状和问题,为进一步加强权限管理提出建议。方法将截至2018年4月底在"中国疾病预防控制信息系统"的用户身份认证管理系统——"用户认证与授权管理系统"注册的、与职业病网络报告工作相关的系统管理员、业务管理员、本级用户、直报用户,使用SPSS 23.0软件对数据进行处理,对用户分布、用户所在机构设置的用户数、用户权限情况等进行分析。结果职业病与职业卫生信息监测系统共有各级各类用户35 144个,其中直报用户最多(24 788个,占70.53%),业务管理员用户最少(2 138个,占6.08%)。直报用户均设为县区级,绝大部分分布在卫生院(11 208个,占45.22%)和医院(8 435个,占34.03%),88.74%的直报机构仅有1个直报账户,3.06%的直报机构有3个及以上直报账户,个别机构直报用户数甚至超过10个。本级用户分布在3 140家职业病报告业务管理机构中,个别地市级和县区级职业病业务管理机构具有5个以上的本级用户。各类机构中大部分用户设置的角色数在5个以内;有15 022个(占60.60%)直报用户使用了"所有报告卡直报角色",主要分布在卫生院。存在的主要问题:基层尤其是县区级职业病防治机构、职业病报告业务管理机构能力不足;部分基层机构用户数设置过多;部分用户权限设置不合理,业务管理员管理欠规范。结论加强基层职业病报告业务管理机构的能力,进一步规范各级各类机构用户和权限管理,业务管理员严格授权,国家出台细化的用户和权限管理规范等措施来进一步加强权限管理工作。     

Familial hypercholesterolaemia: what’s new?

Autosomal Dominant Familial Hypercholesterolaemia (FH) is the commonest inherited disorder of lipoprotein metabolism. Untreated monogenic FH caused by mutations in the LDLR, APOB or PCSK9 genes result in early onset cardiovascular death (below the age of 60 years). In the UK the prevalence of heterozygous FH is 1 in 270 and homozygous FH is 160,000 approximately.The introduction of statins nearly three decades ago has altered the natural history of FH, with a significant reduction of cardiovascular related morbidity and mortality. There is increasing evidence that early childhood interventions such as lifestyle choices, healthy eating and commencing statins by the age of 10 years would potentially prevent early onset cardiovascular disease and mortality in monogenic FH. The medium term safety of statins in children has been demonstrated. The UK paediatric FH register data has shown that children with FH are less obese than the normal population and the register aims to monitor the longer-term safety of statins in children with FH. Child-parent screening would potentially benefit the child and enables identifying a parent with FH, before the onset of a life threatening cardiovascular event. In addition, genetic cascade testing of relatives of an affected individual has been shown to be highly cost effective.We review the current literature with brief updates on genetics, the UK paediatric FH register data, published recommendations for the management of homozygous and heterozygous FH, lipid lowering therapies in children and screening for FH in childhood.     

Simulação de manejo de via aérea difícil para residentes: estudo comparativo prospectivo

Background and objectivesProcedural simulation training for difficult airway management offers acquisition opportunities. The hypothesis was that 3 hours of procedural simulation training for difficult airway management improves: acquisition, behavior, and patient outcomes as reported 6 months later.MethodsThis prospective comparative study took place in two medical universities. Second‐year residents of anesthesiology and intensive care from one region participated in 3 h procedural simulation (intervention group). No intervention was scheduled for their peers from the other region (control). Prior to simulation and 6 months later, residents filled‐out the same self‐assessment form collecting experience with different devices. The control group filled‐out the same forms simultaneously. The primary endpoint was the frequency of use of each difficult airway management device within groups at 6 months. Secondary endpoints included modifications of knowledge, skills, and patient outcomes with each device at 6 months. Intervention cost assessment was provided.Results44 residents were included in the intervention group and 16 in the control group. No significant difference was observed for the primary endpoint. In the intervention group, improvement of knowledge and skills was observed at 6 months for each device, and improvement of patient outcomes was observed with the use of malleable intubation stylet and Eschmann introducer. No such improvement was observed in the control group. Estimated intervention cost was 406€ per resident.ConclusionsA 3 h procedural simulation training for difficult airway management did not improve the frequency of use of devices at 6 months by residents. However, other positive effects suggest exploring the best ratio of time/acquisition efficiency with difficult airway management simulation.ClinicalTrials.gov IdentifierNCT02470195.     

El proceso de institucionalización de la enfermera gestora de casos en España. Análisis comparativo entre los sistemas autonómicos de salud

Care of chronicity is a pressing issue for health systems because of its high prevalence and the organisational challenges that it generates. Different countries solve the complexity of the care of chronicity through case management by the nursing profession, obtaining good results.This paper analyses the status of institutionalisation of the case management nurse in Spain through the design of a reference standard to compare between the autonomous communities in their approach to chronicity. Thus, we sought to monitor the degree of progress of the institutional structure of the policies for the care of chronicity in our country through this healthcare professional. Our results showed that no autonomous community has reached the maximum standard of implementation and that the situation is very heterogeneous, confirming a weak and erratic degree of institutionalisation of the case management nurse in Spain despite the formal recognition of their role in patient care.     

医药分开综合改革对公立医院药师队伍影响的调查

目的：研究公立医院药师队伍受医药分开综合改革的影响。方法：通过文献回顾法对既往研究成果进行整理和综述，通过专家咨询法设计了针对6个省市药师队伍和管理者的调查问卷和访谈提纲，并以此为工具开展调查。结果：改革对药师队伍的工作内容、工作量、工作心态等维度均存在影响，药师队伍对改革政策也有不同评价，对继续教育和医院、政府的支持政策有较大需求。结论：改革促使医疗机构运营策略与药学服务转型，不仅需要药师队伍内部提升，更需要外部设计。