Attention and information processing in end stage renal disease and effect of hemodialysis: a bedside study

Abstract

The neurobehavioral syndrome of uremia in chronic kidney disease affects the functioning of the central nervous system. Cognitive impairment is one of the most important manifestations of this dysfunction. The process of hemodialysis is known to bring about conflicting changes in the cognitive status of patients. In the present study an assessment of cognitive status of patients with end stage renal disease was done in comparison to controls before and after a session of hemodialysis using simple bedside paper-pencil tests. Thirty patients of end stage renal disease on maintenance dialysis for at least one month with MMSE score >24 were assessed one hour before and one hour after hemodialysis using Digit Symbol Substitution Test, One Letter and Three Letter Cancellations tasks. Their results were compared to age and sex matched healthy controls. The patients with end stage renal disease had significantly lower performance in cognitive tests in comparison to controls. The performance improved 1 hour after hemodialysis in comparison to pre-dialysis values. However, the values after dialysis were significantly lower than in controls, thereby indicating that though the cognitive functions improved after hemodialysis, they did not reach the control levels. There was also a significant change in the biochemical parameters after dialysis. We conclude that patients with end stage renal disease suffered from cognitive impairment which improved on hemodialysis due to removal of metabolic waste products.     

Computer assisted management of information in an intensive care unit

Summary In order to use the capability of computers for handling large amounts of information, we developed a program for the acquisition, handling, storage and retrieval of administrative and clinical information generated in the 20 bedded multidisciplinary critical care unit of a University Hospital. At an initial phase a personal computer (PC) was used to collect information from 4362 patients, that included registration data, coded admission problems, techniques and special treatments, and final diagnosis. This information combined with free text provided a discharge report. Complementary programs allowed calculation and storage of hemodynamic and gas exchange parameters. This experience led to a second phase in which a computer with microprocessor Intel 80386 at 25MHz, 8MB RAM, 310 MB hard, disk and a streamer for 150MB cartridge tape back up, using UNIX operating system, permitted multiple users working simultaneously through 1 central console and 7 ASCII terminals. Data input included demographic data, previous and admission problems in coded form, present history and physical examination in free text, list of present problems in coded form, comments on evolution, record of special techniques and treatments, laboratory data, treatment, final diagnosis and facility for using all the information to elaborate the final report. Side modules provide help for drugs dosing, protocols for specific conditions and clerical routines. The system is open for connection to other areas of the Hospital. Data from more than 2000 patients have been included so far. The program is used by medical, nursing and clerical staff with high degree of acceptance. All patients have their clinical information filed and 100% of the final reports are elaborated with the program.We conclude that a PC supported application is not adequate for implementing a historical database. On the contrary the integration of a relational database management system with a text editor in a more potent multiuser set up, provides a highly efficient tool to handle all the data generated during the patients' admission.     

2013年全国医疗机构法定传染病报告卡填报质量调查分析

目的 通过现场调查了解医疗机构法定传染病报告信息的填报质量,发现传染病报告管理中存在的问题。方法 采用分层多阶段整群抽样的方法在全国31个省(自治区、直辖市)和新疆生产建设兵团抽取9个省116家医疗机构开展现场调查。结果 本次调查共收集医疗机构诊疗登记的法定传染病个案共2384例;收集到相应纸质传染病报告卡共2053张。纸质传染病报告卡填写完整率72.28%,其中医生诊断时间、患者工作单位填写完整率最低;与病例登记信息相比,卡片填写准确率为41.35%,发病日期和医生诊断时间准确率最低;与网络报告的电子传染病报告卡相比,卡片填报一致率为68.64%,其中病例的急慢性分型一致率最低。东部地区传染病报告中卡片填写完整率、准确率和一致率均高于中部地区,而西部地区卡片填写的完整率、填报一致率相对最高;不同级别医疗机构中,省级和地市级报告质量指标均较低,乡镇级则相对最高。结论 全国法定传染病疫情填报信息准确性有待进一步提高。医疗机构应加强对院内传染病报告工作的规范和管理,确保传染病报告核心信息来源的准确性;有效利用医院信息系统,充分发挥其对传染病报告的积极作用。     

门诊信息管理系统的应用及效果

应用计算机系统管理门诊信息,使病人能够获得规范、透明、便捷的就诊服务。将挂号收费处、医生工作站、护士工作站及各检查科室的信息通过计算机联网,病人持有预付款的磁卡即可实现“一卡通”服务,即凭卡就诊、预约、检查、治疗、检验、取药。简化了就诊流程,减少了病人排队交费的次数和时间,提高了病人满意度。     

Gait asymmetries are exacerbated at faster walking speeds in individuals with acute anterior cruciate ligament reconstruction

Previous research suggests more biomechanically demanding tasks (e.g., stair descent, hopping) magnify biomechanical asymmetries compared with walking after anterior cruciate ligament (ACL) reconstruction. However, it is unclear if modifying task-specific constraints, like walking speed also elicits greater biomechanical asymmetries in this population. We examined the effects of manipulating walking speed on ground reaction force (GRF) asymmetries in individuals with ACL reconstruction and uninjured controls. Thirty individuals with ACL reconstruction (age = 20.6 ± 5.4 years, body mass index [BMI] = 23.9 ± 3.3 kg/m²) and 15 controls (age = 23.1 ± 4.5 years, BMI = 23.6 ± 2.7 kg/m²) were tested on an instrumented treadmill at three speeds (100%, 120%, and 80% self-selected speed). Bilateral vertical and posterior-anterior GRFs were recorded at each speed. GRF asymmetries were calculated by subtracting the uninjured from the injured limb at each percent of stance. Statistical parametric mapping was used to evaluate the effects of speed on GRF asymmetries across stance. We found vertical and posterior GRF asymmetries were exacerbated at faster speeds and reduced at slower speeds in ACL individuals but not controls (p < .05). No differences in anterior GRF asymmetries were observed between speeds in either group (p > .05). Our results suggest increasing walking speed magnifies GRF asymmetries in individuals with ACL reconstruction. Statement of Clinical Significance: Evaluating both preferred and fast walking speeds may aid in characterizing biomechanical asymmetries in individuals with ACL reconstruction which may be valuable in earlier rehabilitative time points when more difficult tasks like hopping and running are not feasible.     

情绪诱发在护理本科生心肺复苏技能教学中的应用

目的 探讨情绪诱发在护理本科生心肺复苏技能教学中的应用效果。 方法 将2018级35名和2019级31名护理本科生分别设为对照组和观察组。对照组在心肺复苏技能教学中采用教师演示、学生练习、教师指导的传统教学模式,观察组在传统教学模式的基础上融入不同主题的情绪诱发内容。 结果 课程结束后即刻、3个月和6个月观察组心肺复苏技能及心肺复苏施救自我效能得分显著优于对照组（均P＜0.05）,随着时间的推移心肺复苏技能得分无显著下降。 结论 情绪诱发融入式教学可有效提高护理本科生的学习投入度,从而提高学习效果,促进心肺复苏技能、心肺复苏施救自我效能的保留。     

基于病区终端智能柜的低值耗材管理

目的 提高病区低值耗材管理效率。方法 医院联合第三方共同研发病区智能柜系统,与医院物流管理系统、医院信息系统连接,第三方配送、以单体称重和定数包扫码方式完成低值耗材的取用。实施6个月后评价效果。结果 采用智能柜系统管理后,病区低值耗材管理时间、耗材管理满意度显著高于智能柜系统管理前(均P<0.01),病区耗材零库存。结论 基于病区智能柜系统的低值耗材管理模式,有效提高了管理效率,提高了耗材管理满意度。     

Facial deformation following treatment for pediatric head and neck rhabdomyosarcoma; the difference between treatment modalities. Results of a trans-Atlantic,multicenter cross-sectional cohort study

Background

The four different local therapy strategies used for head and neck rhabdomyosarcoma (HNRMS) include proton therapy (PT), photon therapy (RT), surgery with radiotherapy (Paris-method), and surgery with brachytherapy (AMORE). Local control and survival is comparable; however, the impact of these different treatments on facial deformation is still poorly understood. This study aims to quantify facial deformation and investigates the differences in facial deformation between treatment modalities.

Methods

Across four European and North American institutions, HNRMS survivors treated between 1990 and 2017, more than 2 years post treatment, had a 3D photograph taken. Using dense surface modeling, we computed facial signatures for each survivor to show facial deformation relative to 35 age–sex–ethnicity-matched controls. Additionally, we computed individual facial asymmetry.

Findings

A total of 173 HNRMS survivors were included, survivors showed significantly reduced facial growth (p < .001) compared to healthy controls. Partitioned by tumor site, there was reduced facial growth in survivors with nonparameningeal primaries (p = .002), and parameningeal primaries (p ≤.001), but not for orbital primaries (p = .080) All patients were significantly more asymmetric than healthy controls, independent of treatment modality (p ≤ .001). There was significantly more facial deformation in orbital patients when comparing RT to AMORE (p = .046). In survivors with a parameningeal tumor, there was significantly less facial deformation in PT when compared to RT (p = .009) and Paris-method (p = .007).

Interpretation

When selecting optimal treatment, musculoskeletal facial outcomes are an expected difference between treatment options. These anticipated differences are currently based on clinicians’ bias, expertise, and experience. These data supplement clinician judgment with an objective analysis highlighting the impact of patient age and tumor site between existing treatment options.     

Efeito de informações por meio de vídeo sobre a ansiedade e satisfação de pacientes submetidos à anestesia espinhal

Background

Providing sufficient information during a preanesthetic interview may help improve patient understanding and decrease anxiety related to spinal anesthesia. We investigated the effect of video‐based education on anxiety and satisfaction in patients about to undergo spinal anesthesia.

Geographic modeling for children at risk for home fires and burns

This study developed a predictive model for fires and burns among parents and children in Jefferson County, Kentucky. Eight risk factors for pediatric burns with census tract level data available were identified. Risk factors were synthesized to develop a cartographic model with risk levels low, medium, high, and severe. Validation was performed with fire dispatch data. At-risk areas were concentrated in the county’s northwest. Risk was correlated with fire incidence rate (ρ = 0.67, p < 0.001). Significant risk factors were race (β = 0.54, p < 0.001), education (β = 0.38, p < 0.001), and year home built (β = ?0.17, p = 0.005). Cartographic modeling is a underutilized tool to identify at-risk areas.