Pediatric button battery ingestion: A single center experience and risk score to predict severe outcomes

PurposeThe purpose of this study was to analyze the management and outcomes of primary button battery ingestions and their sequelae at a single high-volume center, and to propose a risk score to predict the likelihood of a severe outcome.MethodsThe medical record was queried for all patients under 21 years old evaluated at our institution for button battery ingestion from 2008 to 2021. A severe outcome was defined as having at least one of the following: deep/circumferential mucosal erosion, perforation, mediastinitis, vascular or airway injury/fistula, or development of esophageal stricture. From a selection of clinically relevant factors, logistic regression determined predictors of a severe outcome, which were incorporated into a risk model.Results143 patients evaluated for button battery ingestion were analyzed. 24 (17%) had a severe outcome. The independent predictors of a severe outcome in multivariate analysis were location of battery in the esophagus on imaging (96%), battery size >/ = 2 cm (95%), and presence of any symptoms on presentation (96%), with P < 0.001 in all cases. Predicted probability of a severe outcome ranged from 88% when all three risk factors were observed, to 0.3% when none were present.ConclusionWe report the presentation, management, and complication profiles of a large cohort of BB ingestions treated at a single institution. A risk score to predict severe outcomes may be used by providers initially evaluating patients with button battery ingestion in order to allocate resources and expedite transfer to a center with pediatric endoscopic and surgical capabilities.Level of evidenceLevel IV.Type of studyClinical Research Paper.     

Foreign body granuloma around implantable pulse generator for deep brain stimulation: Two case reports

We report two cases of granuloma that occurred around an implantable pulse generator (IPG) for deep brain stimulation. Both cases showed no signs of infection and disappeared after moving the IPG and removing the granulation. If a noninfectious mass is formed, the relocation of IPG may improve it.     

Infections and foreign bodies in ENT

Infections of the ear, nose and throat are common. The majority of these infections are managed by the primary care physicians and they settle with conservative and medical management. However, a small group can progress to become troublesome and develop complications to the extent that they may require surgical intervention. Some of the infections can lead to life-threatening complications, therefore awareness and correct diagnosis along with appropriate management is paramount. Foreign bodies in the ear, nose and throat are commonly encountered. The location and type of foreign body can have an implication on the urgency of action and the possible complications. In this article the common ENT infections and foreign bodies and their management are discussed.     

留学生临床教学中存在问题及应对策略的探究分析*

目的: 探索留学生临床实习阶段教学中存在的不足之处,寻找行之有效的改进策略。方法: 采用内容分析法,选取10名临床实习的留学生进行半结构访谈,对访谈资料整理汇总提取关键信息,并分析蕴涵的问题,以期寻求最佳的解决路径。结果: 被访留学生表示,目前存在临床上沟通能力弱,操作机会较少,岗位胜任力有待提高等问题。这需要院校联合培养,增强动手能力,提高岗位胜任力。结论: 留学生的培养体系中应增加实践课的课时和比例,同时临床实习中应为他们提供足够的操作机会,包括模拟操作和实际操作。这就需要以政策为上层保障,以院校为主体,以岗位胜任力为出发点,以能力塑造为目标的多方联动、相互认可的培养模式,促进医教协同,提升留学生人才培养成效。     

探索利用外部专家开展信息系统投资审计的方法

本文通过利用外部信息技术专家对信息系统工程投资审计的案例,探索对公立医院信息系统软件开发项目实施投资价格评估的审计方法,并将审计结果加以利用,建立长效机制,制定针对信息系统开发的合同模板,取得软件开发的知识产权,引进监理服务,强化对软件开发公司的全过程质量管理,形成对信息系统投资审计的新模式。     

Scoping Review研究主题分析

目的：了解Scoping review的研究现状,以期为Scoping review的进一步发展提供依据。方法：通过检索主要的外文数据库纳入Scoping review外文研究,采用BICOMS 2分析软件对主题词进行抽取和整理,并生成主题词共现矩阵,利用NetDraw绘制网络关系图,利用gCLUTO进行聚类分析。结果：Scoping review研究有1 516个具有实质意义的主要主题词,研究领域分为6个研究主题,其中5个主题关注健康管理和医疗卫生保健,1个主题关注医药卫生和循证转化医学研究。结论：Scoping review研究的主题主要集中在不同人群的健康管理和医疗卫生保健方面,研究主题较为局限,相关学者应该努力拓展新的研究主题。     

颌面颈部非金属异物的超声诊断评价

目的 探讨B超对颌面颈部非金属异物的诊断价值。方法 对112例颌面部非金属异物进行B超检查并将B超结果与手术结果进行对照分析。结果 B超检查结果经手术证实，其灵敏度、特异度、误诊率、漏诊率、准确度、尤登指数，分别为92.22%、90.90%、0.09、0.08、91.96%、0.83。结论 B超在对颌面颈部非金属异物诊断中，真实、可靠，具有较高的诊断价值。     

快速加热型石膏包埋料对铸造精度影响的研究

目的研究快速加热型石膏包埋料包埋后放置时间对其膨胀及铸件铸造精度的影响。方法选用传统型石膏包埋料CRISTOBALITE P(CBP)、快速加热型石膏包埋料CRISTOBALITE PF(CBPF)和CRISTQUICK20(CQ)。根据包埋料类型及包埋后放置时间不同分组为CBP、CBPF-30、CBPF-60、CQ-20、CQ-40、CQ-60。分别测定各组包埋料的硬化膨胀率和热膨胀率。以六棱柱形状蜡型为铸件原型,应用各组包埋料包埋铸造,测量各组所得铸件的尺寸变化率。结果CBPF-30组、CQ-20组的硬化膨胀率和热膨胀率均小于CBP组。随着包埋后放置时间的延长,CBPF和CQ各组的硬化膨胀率明显增大,热膨胀率逐渐减小。CBPF-30组和CQ-20组包埋料所得铸件的收缩率均大于CBP组。CBPF两组所得铸件的尺寸变化率无差别,CQ3组所得铸件的尺寸变化率无差别。结论在一定限度内适当延长快速加热型石膏包埋料包埋后放置时间对铸件的铸造精度无明显影响。     

颌面深部异物存留的诊断及治疗

目的 研究颌面深部异物存储的诊断及治疗。方法 对28例颌面深部异物存留的病例，从病因，病史，体检，影像学检查进行分析，确定异物存留的诊断；同时从异物的取出，清除病灶，组织修复等方面观察治疗效果。结果 28例中，24例在手术前有明确的诊断；26例进行了异物取出术，清除病灶，修复组织损伤，抗感染及康复治疗。全部病例经6个月以上随访，未发现因异物存留，损伤引起的严重并发症。结论 颌面深部异物存留的诊断应涵盖病因，病史，体检，及影像学诊断内容。对于颌面深部的伤害性异物存留应采取积极的治疗策略，包括取出异物，清除病灶，修复损伤，康复治疗等。多学科协作及微创外科是该类疾病诊断和治疗的发展方向。     

可摘局部义齿误吞致肠穿孔及急性弥漫性腹膜炎1例报告

报道1例62岁女性患者,将`枚可摘局部义齿误吞入消化道。当日急诊未能在胃镜下成功将义齿取出;2d后义齿经过肠道时,在回盲部发生嵌顿,并引发肠穿孔及急性弥漫性腹膜炎。最后,通过剖腹手术取出义齿,并对肠穿孔进行了修补。1周后,腹膜炎治愈后出院。