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Kevin Kyung Ho Choi Santosh Sanagapalli 《World journal of gastrointestinal oncology》2022,14(3):568-586
Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). Progression to cancer typically occurs in a stepwise fashion through worsening dysplasia and ultimately, invasive neoplasia. Established EAC with deep involvement of the esophageal wall and/or metastatic disease is invariably associated with poor long-term survival rates. This guides the rationale of surveillance of Barrett’s in an attempt to treat lesions at an earlier, and potentially curative stage. The last two decades have seen a paradigm shift in management of Barrett’s with rapid expansion in the role of endoscopic eradication therapy (EET) for management of dysplastic and early neoplastic BE, and there have been substantial changes to international consensus guidelines for management of early BE based on evolving evidence. This review aims to assist the physician in the therapeutic decision-making process with patients by comprehensive review and summary of literature surrounding natural history of Barrett’s by histological stage, and the effectiveness of interventions in attenuating the risk posed by its natural history. Key findings were as follows. Non-dysplastic Barrett’s is associated with extremely low risk of progression, and interventions cannot be justified. The annual risk of cancer progression in low grade dysplasia is between 1%-3%; EET can be offered though evidence for its benefit remains confined to highly select settings. High-grade dysplasia progresses to cancer in 5%-10% per year; EET is similarly effective to and less morbid than surgery and should be routinely performed for this indication. Risk of nodal metastases in intramucosal cancer is 2%-4%, which is comparable to operative mortality rate, so EET is usually preferred. Submucosal cancer is associated with nodal metastases in 14%-41% hence surgery remains standard of care, except for select situations. 相似文献
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术后肺部并发症(PPCs)是影响患者围术期预后的主要原因,需要麻醉科医师重点关注并有效防治。越来越多的证据表明,围术期实行肺保护策略可减少PPCs。近5年来,围术期肺保护策略研究已成为围术期医学关注的重点问题之一,围术期肺保护是加速康复外科的重要组成部分,其策略包括术前风险预测、术中肺保护性通气、术后镇痛及物理治疗等。本综述结合围术期肺保护策略最新进展进行阐述,以提高麻醉科医师对PPCs潜在风险的认识,为制定围术期个体化肺保护方案提供策略。未来还应进一步研究以阐明围术期肺保护策略对患者预后结局的影响。 相似文献
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在新冠肺炎疫情波动的环境下,严重精神障碍患者在疫情传播链条节点上的预防措施及应对策略,目前的研究结果尚不明确。从既往的防控经验来看,精神卫生专科医疗机构建立行之有效的新发传染病防控体系以及设立过渡病区等手段,有助于降低疫情传播的风险。然而,对于针对严重精神障碍合并新冠病毒感染的患者,其在诊疗过程中精神症状复发或加重,在方舱医院或传染病房无法配合诊疗的状况,目前的管理策略尚未清晰。本文基于抗疫一线实地调研,围绕严重精神障碍合并新冠病毒感染患者的管理现实困难、紧急状态处理策略、一线精神科医护人员的防护条件以及紧急状态下医护人员处理此类患者的法律依据等方面,对严重精神障碍患者在感染新冠病毒状态下的管理策略进行探讨。 相似文献
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Anna Ugalde BA PhD Victoria White BA MA PhD Nicole M. Rankin BA MSc PhD Christine Paul BA PhD Catherine Segan BA PhD Sanchia Aranda RN BAppSci MN PhD Anna Wong Shee BSc BAppSc PhD Alison M. Hutchinson RN BApp Sci MBioth PhD Patricia M. Livingston BA PhD 《CA: a cancer journal for clinicians》2022,72(3):266-286
Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking-cessation interventions. However, this is not well implemented in practice. In this systematic review, the authors summarize the literature on smoking-cessation implementation strategies and evaluate their success to guide the implementation of best-practice smoking interventions into hospital settings. The CINAHL Complete, Embase, MEDLINE Complete, and PsycInfo databases were searched using terms associated with the following topics: smoking cessation, hospitals, and implementation. In total, 14,287 original records were identified and screened, resulting in 63 eligible articles from 56 studies. Data were extracted on the study characteristics, implementation strategies, and implementation outcomes. Implementation outcomes were guided by Proctor and colleagues' framework and included acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The findings demonstrate that studies predominantly focused on the training of staff to achieve implementation. Brief implementation approaches using a small number of implementation strategies were less successful and poorly sustained compared with well resourced and multicomponent approaches. Although brief implementation approaches may be viewed as advantageous because they are less resource-intensive, their capacity to change practice in a sustained way lacks evidence. Attempts to change clinician behavior or introduce new models of care are challenging in a short time frame, and implementation efforts should be designed for long-term success. There is a need to embrace strategic, well planned implementation approaches to embed smoking-cessation interventions into hospitals and to reap and sustain the benefits for people who smoke. 相似文献
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目的分析静脉用药调配中心用药错误( medication error,ME)的发生情况及特点,提出防范用药错误、保障病人用药安全的策略。方法统计 2018年 1月至 2020年 10月淮南朝阳医院静脉用药调配中心发生的 ME,采用回顾性分析和描述性统计方法,分析 ME的分级、错误内容、引发因素、引发人员、发现人员以及错误涉及药物等。结果共收集到 690例 ME,除 2例为 C级 ME外,其余 688例均为 B级 ME。ME的错误内容中,处方错误发生率最高,其次为核对错误和摆药错误。 ME的引发因素中,以知识欠缺、培训不足和责任心不足为主。 ME的引发人员以医师为主。 ME处方错误中涉及药物以抗微生物类药物、心血管系统药物和消化系统药物为主,这三类药 ME的发生各有其特点; ME处方错误中部分药物呈现错误形式单一的情况。结论该院应加强医师的专业技能培训,静配中心药师医嘱审核应重点关注药物浓度、溶媒和用量,静配中心工作人员责任心亟需加强,应构建精细化、信息化安全用药管理体系,以减少 ME的发生,保障病人安全用药。 相似文献
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AimTo identify factors contributing to Greek nursing students’ stress and the coping strategies used.BackgroundStress experienced by nursing students in the context of ongoing economic recession is as yet unexplored.DesignA cross-sectional study .MethodologyUndergraduate nursing students (n = 424) completed the Student Nurse Stress Index (short version) and the Brief COPE questionnaires during the year 2017.ResultsMost of the participants stated that their current financial status (81.7%) contributed towards their experience of stress, and they had higher scores on the interface worries subscale (p < 0.001). Female gender (p < 0.001) seniority (p = 0.005) and stress of transportation from home to university (p = 0.019) significantly increased the SNSI total score as well as most of the stress subscales scores. As far as coping subscales were concerned, higher means were shown in active/positive coping (mean 2.95), seeking support (mean 2.84), expression of negative feelings (mean 2.71) and avoidance (2.47). However, the use of higher maladaptive coping strategies was noted in cases presenting higher SNSI Total score, interface worries and personal problems.ConclusionThe introduction of stress management training and conflict management skills ought to be considered. Fund raising initiatives should be considered to provide financial assistance to those in need. 相似文献
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Leukaemic variants of cutaneous T-cell lymphoma: Erythrodermic mycosis fungoides and Sézary syndrome
《Best Practice & Research: Clinical Haematology》2019,32(3):239-252
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common types of cutaneous lymphoma, accounting for approximately 60% of cutaneous T-cell lymphomas. Diagnosis requires correlation of clinical, histologic, and molecular features. A multitude of factors have been linked to the aetiopathogenesis, however, none have been definitively proven. Erythrodermic MF (E-MF) and SS share overlapping clinical features, such as erythroderma, but are differentiated on the degree of malignant blood involvement. While related, they are considered to be two distinct entities originating from different memory T cell subsets. Differential expression of PD-1 and KIR3DL2 may represent a tool for distinguishing MF and SS, as well as a means of monitoring treatment response. Treatment of E-MF/SS is guided by disease burden, patients’ ages and comorbidities, and effect on quality of life. Current treatment options include biologic, targeted, immunologic, and investigational therapies that can provide long term response with minimal side effects. Currently, allogeneic stem cell transplantation is the only potential curative treatment. 相似文献