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1.
Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3–13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty.  相似文献   
2.
目的探讨脂蛋白a[Lp(a)]联合单核细胞/高密度脂蛋白胆固醇(HDL-C)比值(MHR)在非ST段抬高型急性冠脉综合征(NSTE-ACS)患者冠状动脉(冠脉)病变严重程度及预后中的评估及其价值。方法选择2020年3月至2021年3月安徽医科大学第一附属医院符合纳入标准的NSTE-ACS患者(n=310),依据冠脉造影结果进行Gensini评分,以Gensini积分的第3四分位数(QU=38)为切点,分为高危组(QU≥38,n=74)和非高危组(QU<38,n=236),比较其一般资料,并使用Logistic回归分析Lp(a)、MHR与冠脉病变严重程度的相关性;使用ROC曲线评估Lp(a)联合MHR评估冠脉病变严重程度及预后的价值。结果高危组和非高危组患者性别、吸烟史、高血压病、糖尿病、高胆固醇血症、肾功能不全等病史、他汀药物应用发生率差异无统计学意义(P>0.05),但高危组患者年龄、血Lp(a)水平和MHR均显著高于非高危组(P<0.01)。Spearman相关分析发现,Lp(a)和MHR分别与Gensini评分呈正相关(r=0.316,P<0.05;r=0.715,P<0.05)。Logistic多因素二元回归分析示,Lp(a)、年龄和MHR是冠脉高危病变的独立危险因素(P<0.01,P<0.05)。ROC曲线分析示,Lp(a)和MHR联合检测对冠脉高危病变评估的AUC(0.854),分别大于Lp(a)和MHR单独检测的AUC(0.852、0.754);联合评估的敏感度73.0%,高于单独检测Lp(a)的55.6%,但低于MHR的82.4%;联合评估的特异度85.6%,高于Lp(a)及MHR单独检测(84.1%、61.9%)。ROC曲线分析示,Lp(a)和MHR联合对NSTE-ACS患者不良预后评估的AUC(0.800),分别大于Lp(a)和MHR单独检测的AUC(0.781、0.739);联合评估患者预后的敏感度为72.2%,高于Lp(a)及MHR单独检测(66.7%、66.7%);联合评估的特异度为81.9%,高于MHR单独检测的80.9%,但低于Lp(a)单独检测的84.8%。结论异常升高的血Lp(a)水平联合MHR对NSTE-ACS患者冠脉病变的严重程度和不良预后具有较高的判断价值。  相似文献   
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This study investigated the role of dual-energy computed tomography (CT) for lesion characterization in patients with peripheral arterial disease manifesting with chronic total occlusions (CTOs). Forty-one symptomatic patients with CTOs underwent dual-energy CT angiography before endovascular treatment. The lesions were subsequently analyzed in a dedicated workstation, and 2 indexes—dual-energy index (DEI) and effective Z (Zeff)—were calculated, ranging from 0.0027 to 0.321 and from 6.89 to 13.02, respectively. Statistical analysis showed a significant correlation between the DEI and Zeff values (P < .001). The interobserver intraclass correlation coefficient was 0.91 for the mean Zeff values and 0.86 for the mean DEI values. This technique could potentially provide useful information regarding the composition of a CTO.  相似文献   
5.
目的 了解毕节市敏感肺结核患者家庭疾病灾难性支出(CTC)及影响因素,为降低患者家庭负担提供政策建议。方法 以2020年5—6月期间毕节市登记并在调查时已成功治疗的敏感患者为调查对象,通过概率比例抽样对其进行问卷访谈。灾难性支出采用率描述,用χ2检验和二分类logistic回归分析其原因。结果 毕节市309例肺结核患者家庭总自付费用 M ( P 25, P 75)为5 169.31(2 098.52,14 778.49)元;直接医疗费用、直接非医疗费用和间接费用 M ( P ? P ?分别为1 688.15(987.31,3 337.50)、720.00(200.00,1 425.00)和1 200.00(0.00,8 390.00),差异具有统计学意义(χ2=63.545, P <0.001)。309例患者家庭CTC发生率为52.43%;其中,家庭年收入较低( OR =25.740,95% CI :9.676~68.473)、住院( OR =3.515,95% CI :1.782~6.933)、确诊延迟( OR =2.492,95% CI :1.297~4.789)是导致其发生CTC的危险因素( P 均<0.05)。结论 毕节市肺结核患者经济负担以间接费用为主,CTC发生率较为普遍。其中,家庭年收入低、住院和确诊延迟患者是其重要危险因素,可针对性地加强患者健康教育、落实医疗机构诊疗规范以及通过政府和社会给予患者补偿,共同降低其疾病负担减少CTC情况。  相似文献   
6.
BackgroundThe purpose of this study is to determine the comparative risk profile and clinical outcomes for patients undergoing reverse total shoulder arthroplasty (RTSA) for cuff tear arthropathy (CTA) without failed prior rotator cuff repair (RCR) compared with RTSA for CTA with prior RCR.MethodsFrom 2006 to 2014, all patients who underwent RTSA by two surgeons after failed RCR with minimum 2-year follow-up were identified. Patients who underwent RTSA with failed prior RCR were matched in a 1:1 ratio to patients undergoing primary RTSA, while controlling for demographic factors, prosthesis design, and surgeon. Postoperative active forward elevation and active external rotation were recorded. Outcome measures included American Shoulder and Elbow Surgeons score, Visual Analog Scale (VAS), and Simple Shoulder Test. Perioperative complications and rates of secondary reoperation were noted, and comparative multivariate analysis was performed.ResultsOf 262 patients, 192 (73.3%) were available at minimum 2-year follow-up. The prior RCR group had a significantly higher complication rate (17.4%, n = 15) than the primary RTSA group (3.8%, n = 4) (P = .001), although no significant difference in periprosthetic infection (P = .469) or secondary revision rate (P = .136) was observed. At mean 36.3 ± 26.1-month follow-up, the prior RCR group had statistically worse American Shoulder and Elbow Surgeons score (P < .001), VAS (P = .001), Simple Shoulder Test (P < .001), and active forward elevation (P = .006). Patients with multiple failed RCR attempts (n = 38) before RTSA demonstrated no significant differences versus isolated failed RCR (n = 48; P > .05).ConclusionThis study demonstrated that patients with RTSA after prior failed RCR have significantly worse patient-reported outcomes and greater rate of perioperative complications than patients undergoing primary RTSA for CTA.  相似文献   
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8.
AIM: To detect an earlier improvement in mild to moderate keratoconus following corneal cross-linking (CXL) with total corneal refractive power (TCRP) using ray tracing method. METHODS: A total of 40 eyes of 30 consecutive patients who underwent CXL for progressive keratoconus were retrospectively enrolled. The following keratometric parameters provided by Pentacam HR, including maximum keratometry (Kmax), steepest keratometry (Ksteep), 3 mm zonal TCRP centered over corneal apex (TCRPapex,zone 3 mm), zonal mean keratometry and TCRP centered over corneal cone (Kmcone,zone and TCRPcone,zone 1, 2, 3 mm) were evaluated preoperatively and 1, 3, 6, and 12mo postoperatively. Groups 1 and 2 were defined based on Kmax at postoperative 1mo as improved (the initial improvement group) or worsen (the initial deterioration group) compared to the preoperative level. RESULTS: In the overall group, only keratometric parameters based on ray tracing method displayed significant improvement early at 3mo postoperatively, in which TCRPcone,zone 1 mm and 2 mm exhibited the largest flattening (0.57 D and 0.53 D, respectively). In Group 1, only Kmax, Kmcone,zone 2 mm and TCRPcone,zone 2 mm showed significant improvement initially at 1mo postoperatively, in which Kmax exhibited the largest improvement (1.05 D), followed by TCRPcone,zone 2 mm (0.82 D). In Group 2, only keratometric parameters based on ray tracing method and Kmcone,zone 3 mm showed slight but not significant improvement early at 3mo, in which TCRPcone,zone 3 mm displayed the most improvement (0.19 D), followed by TCRPcone,zone 2 mm (0.15 D). CONCLUSION: The findings indicate that a 2 mm zonal TCRP centered over Kmax could earlier detect keratometric improvement by CXL compared to other commonly used parameters in mild to moderate keratoconic eyes.  相似文献   
9.
BackgroundSurgical planning of posterior referencing total knee arthroplasty (TKA) using computed tomography (CT) might lead to over-rotation of the femoral component because CT could not detect cartilage thickness of the posterior femoral condyle. The purpose of this study was to examine the rotational alignment difference of the femoral component between magnetic resonance imaging (MRI) and CT.MethodsFor elderly varus osteoarthritic patients, 66 varus osteoarthritic knee patients that underwent primary TKA were selected. Twenty-seven young patients who underwent primary anterior cruciate ligament reconstruction were selected as control. After the transepicondylar axis (CEA), the surgical epicondylar axis (SEA) and the posterior femoral condylar line (PCL) were drawn on CT and on MRI at the same angles as CT. Then, the practical PCL was drawn on MRI considering the cartilage thickness (the cartilage PCL). The angle between the SEA and the cartilage PCL (the cartilage posterior condylar angle (PCA)) was measured as preoperative planning. To investigate the accuracy of preoperative MRI measurement, the cartilage thickness on posterior femoral condyles was directly measured during TKA.ResultsThe cartilage PCA for varus osteoarthritic patients averaged 1.3 ± 1.3°. The cartilage PCA was 1.8 ± 1.0° significantly smaller than the bone PCA (the PCA measured on CT). Meanwhile, the cartilage PCA was 0.2 ± 0.4° significantly larger than the bone PCA in young people. The preoperative angle measurement on MRI strongly correlated with the direct measurement of cartilage thickness during TKA.ConclusionThere was 1.8° of divergence between MRI and CT in varus osteoarthritic patients due to cartilage degeneration of the medial femoral condyle. Cartilage assessment using MRI was useful for femoral component rotational alignment.  相似文献   
10.
目的 探讨引导想象训练对老年髋关节置换术患者疼痛、睡眠情况和精神状态的影响。方法 选取2020年6月~2020年10月某三甲医院收治的拟行髋关节置换手术的老年患者90例,采用随机数字表法将其分为对照组(n=46)和试验组(n=44)。对照组给予基于ERAS的围手术期护理,试验组在对照组的基础上进行运动引导想象训练。分别在术前、术后当天、术后第1天、术后第3天和术后第7天采用疼痛数字分级法(NRS)、理查兹-坎贝尔睡眠量表(RCSQ)和简易智能精神状态评价量表(MMSE)测评患者的疼痛、睡眠及精神状况;同时使用护理谵妄评分(NU_DESC)判断患者住院期间是否发生谵妄。结果 共有87例患者完成研究,总完成率为96.67%。重复测量方差分析结果显示两组患者疼痛、睡眠及精神变化存在时间效应、组间效应及交互效应;术后试验组谵妄发生率低于对照组,差异均有统计学意义(P<0.05)。结论 运动引导想象训练有助于改善老年全髋关节置换患者的疼痛程度、睡眠情况和精神状态。  相似文献   
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