鼻内镜术后不同冲洗液冲洗鼻腔的效果对比

目的:观察鼻渊通窍颗粒稀释液与生理盐水对鼻内镜术后鼻腔冲洗的效果。方法:临床纳入进行功能性内窥镜鼻窦手术患者90例,研究组给予鼻渊通窍颗粒稀释液,对照组给予生理盐水。每周定期对患者进行鼻内窥镜的检查,观察两组患者4周内鼻腔症状以及术腔清洁、囊泡形成、肉芽生成等体征变化情况。结果:两组术后4周冲洗治疗结果表明,两者均有治疗作用,且治疗效果相当,但鼻渊通窍颗粒稀释液冲洗在术后第2周时对术腔痂皮脱落、黏膜水肿、鼻分泌物减少、囊泡形成治疗作用较生理盐水冲洗要好,差异有显著性(P<0.05);研究组治疗4周,总有效率为93.33%,对照组有效率为91.11%,差异无显著性(P>0.05)。结论:鼻渊通窍颗粒稀释液能够有效清洁术后的鼻腔,具有减轻鼻腔黏膜水肿、囊泡再生以及促进黏膜功能恢复等作用。     

Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest,death or unanticipated intensive care unit admission?

IntroductionAlthough the weightings to be summed in an early warning score (EWS) calculation are small, calculation and other errors occur frequently, potentially impacting on hospital efficiency and patient care. Use of a simpler EWS has the potential to reduce errors.MethodsWe truncated 36 published ‘standard’ EWSs so that, for each component, only two scores were possible: 0 when the standard EWS scored 0 and 1 when the standard EWS scored greater than 0. Using 1564,153 vital signs observation sets from 68,576 patient care episodes, we compared the discrimination (measured using the area under the receiver operator characteristic curve—AUROC) of each standard EWS and its truncated ‘binary’ equivalent.ResultsThe binary EWSs had lower AUROCs than the standard EWSs in most cases, although for some the difference was not significant. One system, the binary form of the National Early Warning System (NEWS), had significantly better discrimination than all standard EWSs, except for NEWS. Overall, Binary NEWS at a trigger value of 3 would detect as many adverse outcomes as are detected by NEWS using a trigger of 5, but would require a 15% higher triggering rate.ConclusionsThe performance of Binary NEWS is only exceeded by that of standard NEWS. It may be that Binary NEWS, as a simplified system, can be used with fewer errors. However, its introduction could lead to significant increases in workload for ward and rapid response team staff. The balance between fewer errors and a potentially greater workload needs further investigation.     

Management of cancer in the older adult

Cancer incidence and mortality rise exponentially in the elderly. With the aging of the population there is an urgent need to address this issue with evidence-based guidelines. Delayed diagnosis and incomplete workup and treatment are well documented in this population. Incorporation of a geriatric evaluation in oncology practice should be routinely implemented to prevent adverse outcomes. Treatment decisions in the elderly should not be based solely on survival gains but should also take quality of life into consideration. Cancer treatment is safe and effective in the elderly population. Social issues and other comorbidities should be addressed to improve compliance and outcome. Many unanswered questions regarding the optimal management of elderly cancer patients can be addressed only with the new clinical trials. Eliminating age bias among health care providers by providing education will help achieve optimal care for the elderly with cancer.     

The role of stress as a trigger for epileptic seizures: A narrative review of evidence from human and animal studies

Stress is one of the most frequently self‐identified seizure triggers in patients with epilepsy; however, most previous publications on stress and epilepsy have focused on the role of stress in the initial development of epilepsy. This narrative review explores the causal role of stress in triggering seizures in patients with existing epilepsy. Findings from human studies of psychological stress, as well as of physiologic stress responses in humans and animals, and evidence from nonpharmacologic interventions for epilepsy are considered. The evidence from human studies for stress as a trigger of epileptic seizures is inconclusive. Although retrospective self‐report studies show that stress is the most common patient‐perceived seizure precipitant, prospective studies have yielded mixed results and studies of life events suggest that stressful experiences only trigger seizures in certain individuals. There is limited evidence suggesting that autonomic arousal can precede seizures. Interventions designed to improve coping with stress reduce seizures in some individuals. Studies of physiologic stress using animal epilepsy models provide more convincing evidence. Exposure to exogenous and endogenous stress mediators has been found to increase epileptic activity in the brain and trigger overt seizures, especially after repeated exposure. In conclusion, stress is likely to exacerbate the susceptibility to epileptic seizures in a subgroup of individuals with epilepsy and may play a role in triggering “spontaneous” seizures. However, there is currently no strong evidence for a close link between stress and seizures in the majority of people with epilepsy, although animal research suggests that such links are likely. Further research is needed into the relationship between stress and seizures and into interventions designed to reduce perceived stress and improve quality of life with epilepsy.     

Error bounds for data-driven models of dynamical systems

This work provides a technique for estimating error bounds about the predictions of data-driven models of dynamical systems. The bootstrap technique is applied to predictions from a set of dynamical system models, rather than from the time-series data, to estimate the reliability (in the form of prediction intervals) for each prediction. The technique is illustrated using human core temperature data, modeled by a hybrid (autoregressive plus first principles) approach. The temperature prediction intervals obtained are in agreement with those from the Camp-Meidell inequality. Moreover, as expected, the prediction intervals increase with the prediction horizon, time-series data variability, and model inaccuracy.     

Variability in alignment of central venous pressure transducer to physiologic reference point in the intensive care unit–A descriptive and correlational study

BackgroundThe phlebostatic axis is the most commonly used anatomical external reference point for central venous pressure measurements. Deviation in the central venous pressure transducer alignment from the phlebostatic axis causes inadequate pressure readings, which may affect treatment decisions for critically ill patients in intensive care units.AimThe primary aim of the study was to assess the variability in central venous pressure transducer levelling in the intensive care unit. We also assessed whether patient characteristics impacted on central venous pressure transducer alignment deviation.MethodsA sample of 61 critical care nurses was recruited and asked to place a transducer at the appropriate level for central venous pressure measurement. The measurements were performed in the intensive care unit on critically ill patients in supine and Fowler's positions. The variability among the participants using eyeball levelling and a laser levelling device was calculated in both sessions and adjusted for patient characteristics.ResultsA significant variation was found among critical care nurses in the horizontal levelling of the pressure transducer placement when measuring central venous pressure in the intensive care unit. Using a laser levelling device did not reduce the deviation from the phlebostatic axis. Patient characteristics had little impact on the deviation in the measurements.ConclusionThe anatomical external landmark for the phlebostatic axis varied between critical care nurses, as the variation in the central venous pressure transducer placement was not reduced with a laser levelling device. Standardisation of a zero-level for vascular pressures should be considered to reduce the variability in vascular pressure readings in the intensive care unit to improve patient treatment decisions. Further studies are needed to evaluate critical care nurses' knowledge and use of central venous pressure monitoring and whether assistive tools and/or routines can improve the accuracy in vascular pressure measurements in intensive care units.