Implementation of Nurse-Led Cognitive Screening During Medicare Annual Wellness Visits

Dementia is a serious and costly illness. Early identification of cognitive impairment provides opportunity for earlier intervention, and there is growing evidence suggesting that early intervention may help delay the onset of dementia. There is limited concensus and standardized recommendations for when and how cognitive screening should occur. This quality improvement project implemented a standardized nurse-led cognitive screening workflow during the Medicare annual wellness visit. Statistically significant differences were found between the baseline and implementation groups for Mini-Cog screening rates and referral for follow-up for further neurocognitive evaluation. A structured nurse-led workflow improved the cognitive screening process, providing opportunity for further evaluation and intervention.     

乳腺癌随访和药物副作用管理策略的研究进展

乳腺癌是全球女性发病率最高的恶性肿瘤,随着诊断技术及治疗手段的不断提高,乳腺癌患者接受系统治疗后生存期明显延长。乳腺癌患者需要长时间的随访以便及早监测到局部复发和远处转移。此外,激素敏感性乳腺癌患者还需要给予5~10年的内分泌治疗,针对其副作用的全程管理也需要随访,进而提高患者的生活质量,减轻患者疾病负担。本文就近年来乳腺癌随访相关方面进行简要综述。     

Score du risque échocardiographique après un syndrome coronaire aigu

AimsIdentify the predective echocardiographic parameters of major cardiovascular events (death, ischemic recurrence, heart failure and rehospitalization) in-hospital and after six months of follow-up and to establish an echocardiographic prognostic score and to evaluate its prognostic value alone or in association with clinical risk scores.MethodsWe recruited 302 patients in intensive care unit of cardiology for ACS consecutively on admission, patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting doppler echocardiography, a follow-up of six months.ResultsThe echocardiographic risk score has four variables: LV-EF (RR = 0.931; 95%CI = 0.885–0.979, P < 0.01), RV-AF (RR = 0.951; 95%CI = 0.903–0.999, P < 0.05), iMAE-M-strain (RR = 1.226; 95%CI = 1.081–1.390, P < 0.01) and ULCs (RR = 1.151; 95%CI = 1.081–1.224, P < 0.01). Its discrimination capacity (AUC = 0.85), greater than that of the clinical risk scores, (GRACE: AUC = 0.72, TIMI: AUC = 0.71 and CRUSADE: AUC = 0.76).DiscussionThe risk stratification can be achieved using echocardiographic score easy to acquire and interpret in the clinical setting, with a stratification power higher than the clinical risk scores. The iconoclinical model makes it possible to select a group of heterogeneous patients by their clinical presentations and iconographic data at high risk but with an echoscore or clinical score weak or intermediate.ConclusionThe developed echocardiographic model could prove very useful in the decision-making process and optimization of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four simple echocardiographic variables as predictors.     

Current thinking in the management of adenoid cystic carcinoma of the head and neck

Adenoid cystic carcinoma (ACC) is an aggressive, rare, malignant tumour that accounts for about 1% of all head and neck neoplasms and 10% of all salivary gland tumours. It is characterised by frequent local recurrences and distant metastases. Growth is slow but relentless, and progression poses a challenge to head and neck clinicians. Many small retrospective studies have described its clinical management, but the lack of multicentre, randomised, controlled trials has resulted in inconsistencies in management globally. We have focused on three key management-related controversies: the role of elective neck dissection (END) for the N0 neck; the role of adjuvant treatment or radiotherapy; and finally, the follow-up protocol, particularly cross-sectional surveillance imaging of the full body or chest computed tomography (CT) alone, and options for treatment if metastases are found. The paucity of published studies may reflect the inconsistencies that exist in the management of ACC of the head and neck in the UK. The collaboration of head and neck centres would, we think, help to correct the imbalance in these three domains of care.     

Acetabular erosion following bipolar hemiarthroplasty: A role for the size of femoral head?

Introduction

Femoral neck fractures are the most frequent fractures in the elderly and hemiarthroplasty is the treatment of choice. The objective of this multicenter study is to identify predictive factors of acetabular erosion after bipolar hemiarthroplasty (surgery between 1997 and 2007) in a mobile independent population during a follow-up of ten years.

Predictive factors analysis of the efficacy of cyclophosphamide combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN), and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment. Methods A retrospective cohort study was conducted. Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1, 2007 to December 1, 2016 were enrolled. All subjects were treated with CTX in combination with glucocorticoids. The patients were divided into two groups: remission group and no remission group. Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients. Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5%). Among them, 141 patients (61.8%) had complete remission (CR), the median time for CR was 8(6, 12) months, and the median time for partial remission (PR) was 3(1, 4) months. The median follow-up time for this study was 25(13, 43) months. Compared with the remission group, the serum albumin level was lower in the non-remission group, the 24-hour urine protein content, the blood complement C3 and C4 levels were higher, and the pathological stage was milder (all P﹤0.05). Multivariate logistic regression analysis suggested that the levels of baseline serum albumin, complement C4, and pathological stage were independent predictors of clinical remission in IMN patients. Twenty-four non-remission patients were treated with CNI. The overall response rate was 66.7%(16/24) at 6 months and 77.3%(17/22) at 12 months. Conclusions The levels of baseline albumin, blood complement C4, and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids. The non-remission patients with CTX combined with glucocorticoid therapy can still achieve a higher response rate after adjusting for CNI.     

Comparison of sartorius muscle-pedicle and circumflex iliac deep bone flap grafts in the treatment of early non-traumatic osteonecrosis of femoral head in young adults

ObjectiveThe aim of this study was to retrospectively compare and evaluate the midterm curative effect of two different bone flap grafts in the treatment of early non-traumatic osteonecrosis of the femoral head (ONFH).MethodsA total of 180 patients (199 hips) with early non-traumatic ONFH received surgical treatment by sartorius muscle-pedicle bone flap graft (SMBF) (104 patients, 64 males and 40 females; mean age 34.67 ± 3.24 years) or circumflex iliac deep bone flap graft (CIDBF) (76 patients, 44 males and 32 females; mean age: 35.54 ± 3.37 years) from July 2004 to July 2009. The comparison between the groups was made with Harris score before and after surgery, length of incision, operative time, amount of bleeding, postoperative X-ray. Association Research Circulation Osseous (ARCO) staging was performed.ResultsThe preoperative Harris hip score of two groups were 68.26 ± 1.26 and 69.35 ± 1.31, respectively. Patients' ARCO staging indicated 36 hips of stage IIa, 115 hips of stage IIb and 48 hips of stage IIc. The etiology of ONFH mainly including hormones (93 patients), alcohol (64 patients) and other (23 patients). The mean follow-up time of SMBF and CIDBF groups were (51.78 ± 2.35) and (52.73 ± 3.71) months, respectively. The time of removing sutures, operation time, amount of bleeding and length of incision in SMBF group were superior to those in the CIDBF group, and those differences between the SMBF and CIDBF groups were not significant (all p values > 0.28). The Harris score between the two groups was similar after operation and postoperative 12 month, and the difference was not statistically significant (p > 0.05), whereas the difference of the postoperative 24 and 48 months was statistically significant (p ˂ 0.05). X-ray analysis showed improvement of osteonecrosis in both two groups after surgery, and as time went on, the total hip amount decreased, the replacement amount increased.ConclusionBoth bone flap grafts appear to be effective methods for treatment of early osteonecrosis of femoral head (ARCOⅡ), and the SMBF is a relatively simple technique and easy for mastering, and it is a reliable method for clinical application.Level of evidenceLevel III, Therapeutic Study.