The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: The use of mechanical circulatory support in lung transplantation

ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.     

The effect of malpractice law on physician supply: Evidence from negligence-standard reforms

We explore whether the composition of the physician workforce is impacted by the clinical standards imposed on physicians under medical liability rules. Specifically, we explore whether the proportion of non-surgeons practicing in a region decreases—and thus whether the proportion of surgeons increases—when liability standards are modified so as to expect that physicians practice more intensively. For these purposes, we draw on a quasi-experiment made possible by states shifting from local to national customs as the basis for setting liability standards. Using data from the Area Health Resource File from 1977 to 2005, we find that the rate of non-surgeons among practicing physicians decreases by 2–2.4 log points (or by 1.4–1.7 percentage points) following the adoption of national-standard laws in initially low surgery-rate regions—i.e., following a change in the law that effectively expects physicians to increase their use of surgical approaches.     

耳鸣评价量表（TEQ）的耳鸣疗效评定新标准探索

目的通过对比耳鸣评价量表(TEQ)治疗前后得分变化和等级变化计算的疗效,并与耳鸣残疾评估量表(THI)的疗效相对比,为TEQ评估耳鸣疗效的评定标准提供参考。方法 TEQ得分疗效是根据国际上使用的标准差/2原则,即治疗前后得分变化≥TEQ初诊得分标准差/2视为治疗有效;TEQ等级疗效是TEQ等级变化≥1级视为治疗有效。THI得分疗效标准分为文献推荐的变化≥7分和变化≥20分,及标准差/2计算的变化≥12分分别视为有效。结果本次调查的165例患者中,按TEQ得分原则(SD/2原则)、TEQ等级原则、THI7分原则、THI12分原则(SD/2原则)及THI20分原则计算的疗效分别为60.00%、49.09%、61.82%、52.73%、及32.73%。通过卡方检验,TEQ得分疗效及TEQ等级疗效与THI7分及THI12分疗效比较均无统计学差异(P>0.005),均明显高于THI20分疗效(P<0.005)。结论使用耳鸣评价量表(TEQ)进行耳鸣疗效评定时,除了通过等级变化外,还可以采用以治疗前后得分变化为基础的疗效评定标准。     

Effects of a projector-based hybrid virtual reality on pain in young children with burn injuries during hydrotherapy sessions: A within-subject randomized crossover trial

AimThe aim of this study was to examine the effect of a water-friendly Projector-Based Hybrid Virtual Reality (VR) dome environment combined with standard pharmacological treatment on pain in young children undergoing burn wound care in hydrotherapy.MethodsThis study was a prospective, within-subject crossover trial of 38 children aged 6 months to 7 years old (mean age = 1.8 years old). Each hydrotherapy procedure was divided into two equivalent wound care segments (No hybrid VR during one segment vs. Hybrid VR during the other segment, treatment order was randomized). Pain was measured using the 0–10 FLACC (Face, Legs, Activity, Cry Consolability scale) and the 0–10 NRS-obs (Numerical Rating Scale-obs).ResultsProjector-Based Hybrid VR significantly reduced procedural pain levels measured by the FLACC (p = 0.026) and significantly increased patients' comfort levels (p = 0.002). Patients' pain levels rated by the nurses using the NRS-obs were non-significant between both groups (p = 0.135). No side effects were reported.ConclusionProjector-Based Hybrid VR helped in reducing the pain related to hydrotherapy procedures in young children with burn wound injuries. This is the first study using virtual reality distraction with young children, and our findings are especially important because a large percentage of pediatric burn patients are very young. Additional research and development are recommended.Trial registrationClinicalTrials.gov, NCT02986464, registered on June 12, 2016.     

热敏灸小镇建设助力江西热敏灸产业发展的对策研究

近年来,江西资溪、丰城等地的实践探索表明,热敏灸小镇建设对于助推江西热敏灸产业发展具有十分重要的作用。然而,当前江西热敏灸小镇建设在标准、人才、组织、产品、服务等方面还存在诸多问题。为此,有必要在借鉴省外成功经验的基础上,从找准定位、培养人才、规范管理、健全标准、强化保障等五个方面进一步加强热敏灸小镇建设,助力江西热敏灸产业发展。     

Évaluation de l’utilisabilité des poches industrielles de nutrition parentérale

ObjectivesTo assess the compliance of parenteral nutrition bags to standards and to evaluate the ease of use and the time required to mix the different compartments of bags sold on the French market in 2014.Materials and methodsThree in vitro tests have been carried out: volume measurement, tests of penetration and adhesion of the infusion needle. Users evaluated the various stages of bags preparation using the Likert scale. The reading time of the instruction guide and the preparation time of the bags were recorded.ResultsAccording to in vitro tests, all bags were in conformity with the standards. The assessment of ease of use revealed variations between the different bags. Bags with two compartments displayed similar general appreciation but a different handling time. Two ranges of bags with three compartments for central line (Olimel^® and Kabiven^®) obtained different results in terms of general appreciation and handling time. One of three ranges of bags with three compartments for administration via peripheral route got better appreciations and a lower handling time than the two others.ConclusionAll bags were in conformity with standards in terms of volume and connection between the bag and the infusion set. The handling test showed variations of the preparation time and the ease of use.     

An Environmental Scan of the National and Provincial Diagnostic Reference Levels in Canada for Common Adult Computed Tomography Scans

Several regulatory bodies have agreed that low-dose radiation used in medical imaging is a weak carcinogen that follows a linear, non-threshold model of cancer risk. While avoiding radiation is the best course of action to mitigate risk, computed tomography (CT) scans are often critical for diagnosis. In addition to the as low as reasonably achievable principle, a more concrete method of dose reduction for common CT imaging exams is the use of a diagnostic reference level (DRL). This paper examines Canada's national DRL values from the recent CT survey and compares it to published provincial DRLs as well as the DRLs in the United Kingdom and the United States of America for the 3 most common CT exams: head, chest, and abdomen/pelvis. Canada compares well on the international scale, but it should consider using more electronic dose monitoring solutions to create a culture of dose optimization.