新冠肺炎危重症患者收治医院护理人力资源应急管理策略

面对新型冠状病毒肺炎疫情,积极与各医疗队进行沟通协调,护理部积极统筹部署,采取系列应急管理策略:梯队调配、建立规章制度、严格岗前培训、提供心理支持和后勤保障等,从而科学合理地进行人力资源管理,对新型冠状病毒肺炎防治工作顺利进行起到积极作用。     

Clinical observation on the effect of Chinese medicine-“TCM formula” intervention on recurrence and metastasis of triple negative breast cancer

ObjectiveThis study used a prospective cohort study to observe the effect of triple-negative breast cancer on the 2-year disease-free survival rate with or without “TCM formula”.MethodsFrom November 1 st, 2016, the first patient was enrolled in the cohort study. A total of 356 patients were enrolled on January 30, 2019. Among them, 154 cases were followed up for 2 years. During the follow-up, there were 6 cases of shedding, so 6 cases were affected. A total of 148 cases were included in the analysis, including 73 in the exposed group and 75 in the non-exposed group. The exposed group was given “TCM formula” on the basis of standardized treatment, and the non-exposed group was treated with simple triple-negative breast cancer. The two groups visited each of the three months. The interview included safety examination (hematology and imaging). The endpoint was the difference in 2-year invasive disease-free survival between the exposed and non-exposed groups and the safety of the “TCM formula”.ResultsThere were 6 cases of shedding during the experiment and the shedding rate was 3.9 %. The 2-year rate of invasive disease-free survival in the exposed team was 88.7 % and the non-exposed group was 82.5 %. Logistic multivariate regression analysis predicted that “TCM formula” could reduce the disease-related recurrence and metastasis rate by 11 % (OR = 0.89, 95 % CI 0.37−0.956, P＜0.05). Through K–M survival analysis, TNBC patients with age ≤35 years and regional lymph node stage N1 may be the benefit group of “TCM formula”(P＜0.05). During the study, the incidence of total adverse events was 8.2 % in the exposed group, mainly manifested as stomach discomfort, diarrhea, and hepatocyte damage.Conclusion1. In the exposed group, the two-year rate of invasive disease-free survival increased by 6.2 % compared with the non-exposed group(P＞0.05). 2. According to K–M survival analysis, TNBC patients with age ≤35 years and regional lymph node metastasis to N1 may be potential beneficiaries of “TCM formula”. 3. “TCM Formula” is safe and tolerable to most patients.     

Diabetes treatment and hypoglycaemic episodes in elderly patients at nursing homes in Uppsala County

Aim: The aim of this study was to examine the situation for elderly patients with diabetes living in nursing homes with regard to diabetes treatment, clinical variables, and vascular complications associated with diabetes. A second aim was to evaluate if the patients were at risk of hypoglycaemia.

Methods: This was a cross-sectional study including diabetes patients from all 30 nursing homes in Uppsala County, Sweden. Current antidiabetic medications, HbA_1c, hypoglycaemic events, and diabetes complications were registered from the medical records. The patients were stratified into a general group and divided into three groups according to HbA_1c (<52, 52–73, and >73?mmol/mol).

Results: Of 1,350 individuals, 218 patients were identified with diabetes mellitus. The diabetes duration was 11.2?±?9.4 years and their serum HbA_1c concentration 56.0?±?1.2?mmol/mol. Hypoglycaemic events were reported in 24% of the diabetic individuals, and 43.1% of them had HbA_1c <52?mmol/mol (mean value 44.0?±?1.1?mmol/mol). Of these, 36% were taking antidiabetic drugs. Another 35.8% of the patients had HbA_1c values between 52–73?mmol/mol (mean value 60.0?±?1.1?mmol/mol), and 82% of these patients were taking antidiabetic drugs. Almost 80% of the diabetic patients had either micro- or macrovascular complications, with diabetes duration as an association for both micro- or macrovascular complications and hypoglycaemic events.

Conclusions: A reduction of the use of antidiabetic drugs with follow-up of HbA_1c level should be considered, especially for multimorbid elderly patients with low HbA_1c and hypoglycaemia.     

Reducing HIV stigma among healthcare providers in India using a partly tablet-administered intervention: the DriSti trial

ABSTRACT

HIV stigma has long been recognized as a significant barrier in the worldwide fight against HIV. Across cultures, stigma has been shown to cause psychological distress and act as a barrier to engagement in care. Health professionals can serve as a crucial source of HIV stigma, with drivers that include fears and transmission misconceptions and pre-existing negative attitudes towards marginalized groups. To increase their impact, stigma reduction interventions need to be scalable and sustainable as well as adaptable to different cultural contexts. The DriSti intervention was designed to meet these needs through an easily adaptable, mostly tablet-administered, interactive intervention delivered to ward staff (n?=?1,557) and nursing students (n?=?1,625) in 62 Indian institutions, using a cRCT design, with wait-list controls. Six-month outcome analyses, showed significant reductions in misconceptions (p?<?.001) and worry about acquiring HIV at work (p?<?.001). Intervention participants also reported significantly greater reductions in endorsement of coercive policies (p?<?.001) and in the number of situations in which they intended to discriminate against PLWH (p?<?.001) than control participants. This brief, scaleable intervention could be adapted for similar populations in the region, using different mHealth platforms and thus has important implications for current global stigma reduction initiatives and training curricula.     

机器人辅助下钻孔减压治疗股骨头坏死与传统手术的对比

文题释义：股骨头缺血性坏死：由创伤性和非创伤性原因引起的股骨头病变的病理过程，临床以髋关节疼痛、功能障碍为主要表现。此病病程长、预后差，易引起股骨头塌陷，引起髋关节退变，股骨头坏死早期可行钻孔减压治疗，后期需要行全髋关节置换。 钻孔减压：即髓芯减压，是在1964年由Arlet和Float首创，空心钻头在克氏针的引导下沿克氏针由股骨大转子外侧向股骨头坏死区域定位，到达股骨头皮质下方。股骨头中间形成孔道使股骨头起到减压的效果。背景：为了延缓早期股骨头坏死的进一步加重，股骨头钻孔减压是一种较好的治疗方法，但传统股骨头钻孔减压手术创伤大。 目的：对比机器人辅助下钻孔减压治疗股骨头无菌性坏死与传统手术疗效的差异。 方法：纳入40例行股骨头无菌性坏死钻孔减压患者进行回顾性对比分析，根据治疗方案分为2组。机器人组在机器人辅助下对18例(26个股骨头)进行股骨头钻孔减压治疗，其中FicatⅠ期13例(18个股骨头)，FicatⅡ期5例 (8个股骨头)；传统手术组共22例患者(29个股骨头)，其中FicatⅠ期15例 (19个股骨头)，FicatⅡ期7例(10个股骨头)。对比2组患者的手术切口、术中透视次数、术中出血量、术中穿刺次数及手术时间，术前及术后1，3，6个月根据Harris评分评估髋关节功能。结果与结论：①所有患者均随访6个月以上；②机器人组术中切口长度、术中出血量、透视次数、术中穿刺次数、手术时间均优于传统组，差异有显著性意义(P < 0.05)；③2组患者术后1，3，6个月Harris评分相比差异均无显著性意义(P > 0.05)；④提示与传统术式相比，机器人辅助下钻孔减压治疗股骨头无菌性坏死的疗效方面并未见明显优势，但其手术切口小，术中透视次数少，创伤小，操作更加安全微创。 ORCID: 0000-0002-1809-7037(罗进) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

Epigenetic regulation of insulin action and secretion – role in the pathogenesis of type 2 diabetes

The prevalence of type 2 diabetes (T2D) is rapidly increasing worldwide. Obesity, physical inactivity and ageing increase the risk of T2D. Epigenetic modifications can change due to environmental exposures and may thereby predispose to disease. This review aims at summarizing recent advances in epigenetics related to T2D, with a special focus on impaired insulin action and secretion in humans. There will be an emphasis on analyses in human tissues; both from T2D case‐control cohorts and intervention studies. Current data support an important role for epigenetics in the pathogenesis of T2D. Numerous studies have found differential DNA methylation and gene expression in skeletal muscle, adipose tissue, the liver and pancreatic islets from subjects with T2D compared with nondiabetic controls. For example, PDX1 has increased DNA methylation and decreased expression in pancreatic islets from patients with T2D compared with nondiabetic controls. Nongenetic risk factors for T2D such as ageing, unhealthy diets and physical activity do also impact the epigenome in human tissues. Interestingly, physical activity altered DNA methylation of candidate genes for T2D such as THADA in muscle and FTO, KCNQ1 and TCF7L2 in adipose tissue. There is also a strong interaction between genetic and epigenetic factors that together seem to affect T2D. mQTL studies in human adipose tissue and pancreatic islets showed that SNPs associated with DNA methylation levels in numerous sites. Several of these SNPs are also associated with T2D. Recent data also support that DNA methylation of some sites in blood may be developed into biomarkers that predict T2D since methylation of, for example TXNIP, ABCG1 and SREBF1 associated with future T2D. Future studies should use this information for development of new therapies and biomarkers and thereby improve prediction, prevention and treatment of T2D and its complications.