沙利度胺在局部晚期非小细胞肺癌中抗血管生成作用的研究

目的探讨沙利度胺在治疗局部晚期非小细胞肺癌中的抗血管生成作用。方法以该院2012年10月至2014年1月收治的40例局部晚期非小细胞肺癌患者作为研究对象,分为对照组(单纯同步放、化疗)和治疗组(在对照组基础上联合沙利度胺),每组各20例。同步放疗剂量60Gy,6周30次;化疗方案为PC(紫杉醇45~50mg/m~2,1次/周+卡铂AUC=2,1次/周)/EP(顺铂50mg/m~2第1、8、29、36天+VP16 50mg/m~2第1~5天、第29~33天);沙利度胺每日200mg口服,第1天起持续10周。采用酶联免疫吸附试验检测全部患者0、6、10周血清血管内皮细胞生长因子(VEGF)水平。结果治疗后第10周,治疗组VEGF水平[(220.35±82.61)pg/mL]明显低于对照组[(292.76±152.06)pg/mL],差异有统计学意义(P0.05)。治疗组近期疗效有效率(55%)高于对照组(40%),但差异无统计学意义(P0.05)。治疗组睡眠改善、体质量增加、食欲增加和疼痛缓解情况均优于对照组,差异均有统计学意义(P0.05)。对照组受益4例,治疗组受益17例,差异有统计学意义(χ~2=16.942,P=0.000)。对照组和治疗组治疗后在非血液学毒性和血液学毒性方面差异均无统计学意义(P0.05)。结论沙利度胺联合EP/PC方案同步放、化疗可显著降低血清VEGF水平,提高局部晚期非小细胞肺癌患者临床受益率,且未增加毒副作用。     

沙利度胺联合化疗治疗实体瘤疗效观察

目的研究沙利度胺在晚期癌症患者中的辅助治疗作用。方法将已有病理确诊的63例晚期癌症患者随机分配至治疗组(n=31)与对照组(n=32)。治疗组患者予以沙利度胺联合化疗,对照组患者单纯予以化疗。观察两组的有效率及副反应。结果治疗组与对照组的有效率分别是54.8%与31.2%,2组间的有效率具有统计学差异(P<0.05)。2组间的副反应无统计学差异。结论在晚期癌症的治疗中采用沙利度胺联合化疗不但能提高疗效,而且并不增加化疗的不良反应。     

单疗程沙利度胺联合CTOD方案治疗多发性骨髓瘤22例

目的评价沙利度胺联合CTOD(环磷酰胺、吡柔比星、长春新碱、地塞米松)化疗方案治疗多发性骨髓瘤22例的疗效和不良反应。方法22例患者均给予小剂量沙利度胺联合化疗,沙利度胺的剂量为50～200mg/d,环磷酰胺(CTX)500～600mg/m2×1d,吡柔比星(THP)20mg/m2×(2～3)d;长春新碱(VCR)2mg/m2×1d,地塞米松(Dex)10～15mg/m2×(5～7)d;每2～3月重复,有效可继续化疗2～4次。结果患者一疗程总有效率为90.90%(完全缓解率为4.54%,部分缓解率86.36%),主要不良反应为骨髓抑制,白细胞和血小板分别在化疗后第5～12天、第5～14天降到最低值,外周血象一般在11～15d恢复正常。不良反应不明显,无1例患者因化疗发生不良反应而死亡。结论沙利度胺联合CTOD化疗方案治疗多发性骨髓瘤的较理想方案。     

沙利度胺联合托烷司琼治疗乳腺癌辅助化疗相关呕吐的疗效观察

目的:了解沙利度胺联合托烷司琼治疗乳腺癌辅助化疗所致恶心呕吐的疗效及不良反应.方法:将52例术后化疗的乳腺癌患者随机分为A、B两组,每组各26例,A组:静脉用托烷司琼5 mg,第1天+口服地塞米松5 mg,1天2次,第1天;B组:静脉用托烷司琼5 mg,第1天+口服沙利度胺25 mg,1天2次,第1天.评价两组的止吐效果和副作用.结果:46例患者可评价疗效,两组恶心呕吐控制情况完全控制、基本控制、轻度控制、未控制百分率分别为:8.0%vs.33.3%、52.0%vs.57.1%、32.0%vs.9.5%、8.0%vs.0%,治疗有效率为60.0%vs.90.5%(χ2=5.498,P=0.019),差异有统计学意义.两组患者腹泻、困倦、凝血功能异常、骨髓抑制和感觉异常等副作用的发生率差异无统计学意义.结论:联合应用沙利度胺能够有效控制乳腺癌辅助化疗相关性恶心呕吐,副作用容易耐受,是可供选择使用的止吐药物.     

TXT+FOLFOX4方案联合沙利度胺治疗晚期胃癌的疗效

目的观察TXT+FOLFOX4方案联合沙利度胺一线治疗晚期胃癌的临床疗效及安全性。方法对36例晚期胃癌患者采用TXT+FOLFOX4方案联合沙利度胺进行治疗,2周为1个周期,化疗4个周期后行疗效评价。结果所有病例均可评价,完全缓解(CR)0例,部分缓解(PR)21例(58.3%),稳定(SD)11例(30.5%),进展(PD)4例(11.1%)。患者出现的主要不良反应为粒细胞减少、外周神经毒性、乏力、贫血、粒细胞减少等。结论 TXT+FOLFOX4方案联合沙利度胺治疗晚期胃癌有较好的疗效,是很好的晚期胃癌一线化疗方案之一。     

常规化疗联合低剂量沙利度胺治疗多发性骨髓瘤的临床效果

目的分析常规化疗联合低剂量沙利度胺治疗多发性骨髓瘤的临床效果。方法回顾性选取2018年1月至2019年1月本院收治的100例多发性骨髓瘤患者,依据治疗方法将其分为常规化疗组(n=50,常规化疗)、沙利度胺组(n=50,常规化疗联合低剂量沙利度胺)。比较两组的临床效果。结果治疗后,沙利度胺组的骨髓细胞计数、M蛋白水平低于常规化疗组,血红蛋白、IL-35水平均高于常规化疗组(P<0.05)。沙利度胺组的总缓解率高于常规化疗组(P<0.05)。两组的不良反应总发生率无显著差异(P>0.05)。沙利度胺组的无进展生存期及总生存期均长于常规化疗组(P<0.05)。结论常规化疗联合低剂量沙利度胺治疗多发性骨髓瘤的临床效果较常规化疗显著,能更有效地提升患者的IL-35水平。     

低剂量分次放疗增敏化疗治疗晚期结直肠癌的临床研究

目的初步确定50cGy/次,2次/d,每一化疗周期的第1、2d应用的低剂量分割放疗方式的化疗增敏作用的有效性及可行性,寻找低剂量放疗化疗增敏的最佳放疗剂量及剂量分割方式。方法选取本院40例晚期结直肠癌患者,分为两组各20例,对照组使用常规化疗,试验组则联合低剂量分次放疗增敏(放疗50cGy/次,2次/d,1 d、2 d,共2 d),对比两组的治疗有效率、无进展生存期和毒副反应。结果试验组总缓解率75.00%(15/20)高于对照组45.00%(9/20)(χ^(2)=5.554,P<0.05),血清CEA、CA199水平低于对照组(P<0.05)。两组毒副反应发生率60.00%(12/20)、45.00%(9/20)间差异不显著(χ^(2)=1.669,P>0.05)。试验组无进展生存期(8.13±1.51)月长于对照组(6.22±1.30)月(t=5.250,P<0.05)。结论晚期结直肠癌治疗中低剂量分次放疗增敏化疗能提高近期有效率,延长无进展生存期,安全性好。     

沙利度胺联合GP方案治疗晚期非小细胞肺癌

目的:观察沙利度胺联合GP方案治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效及不良反应.方法:54例患者随机分为治疗组(26例)及对照组(28例):治疗组采用GP方案加沙利度胺治疗,具体为吉西他滨1 000 mg/m2,静滴d1,8;顺铂75 mg/m2,d1-3,沙利度胺100 mg/d 口服,一周后加至200 mg/d.对照组采用GP方案化疗,剂量方法与治疗组相同.结果:治疗组和对照组的有效率分别为46.1%和32.1%,两者无显著差异(P ＞ 0.05),但中位肿瘤进展时间由3.4月延长至5.8月.患者生存质量明显提高.治疗组及对照组的毒副反应发生率无显著差异(P ＞ 0.05).结论:沙利度胺联合GP方案治疗晚期非小细胞肺癌显著提高疗效,毒副反应无明显增加.     

恩度联合FOLFOX4方案治疗晚期结肠癌、直肠癌的多中心临床研究

目的评价重组人血管内皮抑素（恩度）联合FOLFOX4方案治疗晚期结肠癌、直肠癌的有效性和安全性。方法 2006年7月~2010年12月,58例晚期结肠癌、直肠癌患者接受恩度联合FOLFOX4方案：恩度7.5 mg/m2第1~7天,草酸铂85 mg/m2,静滴2 h,第1天;醛氢叶酸200 mg/m2,第1、2天;5-氟尿嘧啶（5-Fu）400 mg/m2,静推,第1、2天;5-Fu600 mg/m2,静滴22 h,第1、2天。2周重复,至少4周期。结果 17例获部分缓解,24例获病情稳定,总有效率为29.3%,临床受益率为70.7%,中位疾病进展时间（TTP）为8.6月,主要毒副反应为中性粒细胞减少（50.0%）,恶心/呕吐（39.7%）,神经毒性（39.7%）。结论恩度联合FOLFOX4方案治疗晚期结肠癌、直肠癌疗效确切,毒副反应可耐受。     

沙利度胺联合化疗治疗35例恶性肿瘤临床疗效观察

目的观察沙利度胺联合化疗方案治疗恶性肿瘤的临床疗效及不良反应。方法选取2007年6月～2009年12月本院收治的恶性肿瘤患者35例,经沙利度胺联合化疗方案治疗后,观察近期临床疗效及不良反应发生情况。结果 35例患者治疗有效率为54.3%,临床收益率为94.3%。出现不同程度胃肠道、血液系统及皮肤不良反应。35例患者中,生活质量改善19例(54.3%);睡眠大致正常20例(57.1%);体质重改善17例(48.6%)。结论沙利度胺联合化疗对恶性肿瘤有一定疗效,不良反应小,患者依从性好。     

患者暴力事件对肿瘤医院护士工作满意度的影响

目的探讨肿瘤医院患者暴力事件及护士工作满意度的相关性,分析影响护士工作满意度的因素。方法采用一般资料问卷、患者暴力事件量表和护士工作满意度量表对肿瘤医院306名护士进行问卷调查。结果患者暴力事件评分为(10.07±3.62)分,肿瘤医院护士工作满意度评分为(114.26±31.59)分,二者呈负相关(P0.01),肿瘤医院护士职称和患者暴力事件为工作满意度的主要影响因素(P0.01)。结论肿瘤医院患者暴力事件发生率较高,医院管理者应采取针对性措施,降低患者暴力事件的发生率,改善护士的工作满意度和护理质量。     

Evidence-based implementation of adult asthma guidelines in the emergency department: a controlled trial

Objective: To determine if an evidence‐based implementation (EBI) strategy could lead to the successful implementation of guidelines for the management of adult asthma in a large rural ED. Methods: This was a pre‐ and post‐intervention trial, comparing data for seven clinical indicators from a study hospital and a control hospital. Retrospective pre‐intervention audits were conducted at the study hospital for 3 months (1 April?30 June 2004) and the control hospital for 4 months (1 March?30 June 2004). The effect of an EBI to implement established guidelines for the management of asthma at the study hospital was compared with the effect of a mail‐out of guideline booklets and wall charts to the control hospital. Post‐intervention audits were then performed at both hospitals. Sustainability of the EBI was gauged by 12 month follow‐up data at the study hospital. Results: There were 55 presentations of adult asthma at the study hospital in the pre‐intervention phase and 67 post‐intervention. The corresponding numbers for the control hospital were 51 and 42, respectively. Following the EBI there were significant improvements at the study hospital for the documentation of severity (27–99%, P < 0.01), use of spirometry (38–84%, P < 0.01), medication delivery via spacer device (0–26%, P < 0.01), use of systemic steroids (66–84%P < 0.05), use of written short‐term asthma plans (14–82%, P < 0.01), reduction of ipratropium use in mild asthma (43–16%, P < 0.05) and reduction in antibiotic use in afebrile asthmatics (37–6%, P < 0.01). For the control hospital there was a significant increase in spirometry use from 2% to 40% (P < 0.01). For seven clinical indicators combined, compliance with the guideline increased from 38% to 79.1% (P < 0.01) at the study hospital, whereas there was no change at the control hospital, 44.3% to 43% (P = 0.75) There were 68 presentations at 12 month follow up at the study hospital and compliance with the seven clinical indicators was 78.2%. Conclusion: An EBI significantly improved compliance at the study hospital with no improvement noted in the control hospital. These improvements were maintained at 12 month follow up. An EBI can lead to significant improvements in the management of asthma at a large rural referral hospital ED and might have implications for hospitals with similar roles and profiles.     

三种类型医院抗精神病药物使用情况比较

目的：比较三种不同类型医院抗精神病药物使用情况，为临床用药提供参考。方法：采用全国精神科药物使用调查表同时对一所教学医院精神科门诊患者94例（13－84岁）、住院患者119例（12－76岁）一所市级精神病院门诊患者95例（17－77岁）、住院患者142例（14－77岁）；和一所区级精神病院门诊患者34例（19－72岁）、住院患者117例（20－70岁）在连续5天内抗精神病药物使用情况进行调查。结果：不同类型医院患者的人口学资料和一般情况有差异；在教学医院，患者的首次入院和诊断抑郁症的比例较高；住院时间较短；非典型抗精神病药的应用比例较其他类型的医院高，以维思通和氯氮平的应用为主；在联合用药方面，联合应用氯氮平的比例最高；在不同类型的医院，典型抗精神病药舒必利的应用比例均居首位。结论：不同类型医院使用抗精神病药物情况不同，教学医院使用非典型抗精神病药的比例较高。     

The Surgical Optimal Mobility Score predicts mortality and length of stay in an Italian population of medical,surgical, and neurologic intensive care unit patients

PurposeWe validated the Italian version of Surgical Optimal Mobility Score (SOMS) and evaluated its ability to predict intensive care unit (ICU) and hospital length of stay (LOS), and hospital mortality in a mixed population of ICU patients.Materials and MethodsWe applied the Italian version of SOMS in a consecutive series of prospectively enrolled, adult ICU patients. Surgical Optimal Mobility Score level was assessed twice a day by ICU nurses and twice a week by an expert mobility team. Zero-truncated Poisson regression was used to identify predictors for ICU and hospital LOS, and logistic regression for hospital mortality. All models were adjusted for potential confounders.ResultsOf 98 patients recruited, 19 (19.4%) died in hospital, of whom 17 without and 2 with improved mobility level achieved during the ICU stay. SOMS improvement was independently associated with lower hospital mortality (odds ratio, 0.07; 95% confidence interval [CI], 0.01-0.42) but increased hospital LOS (odds ratio, 1.21; 95% CI: 1.10-1.33). A higher first-morning SOMS on ICU admission, indicating better mobility, was associated with lower ICU and hospital LOS (rate ratios, 0.89 [95% CI, 0.80-0.99] and 0.84 [95% CI, 0.79-0.89], respectively).ConclusionsThe first-morning SOMS on ICU admission predicted ICU and hospital LOS in a mixed population of ICU patients. SOMS improvement was associated with reduced hospital mortality but increased hospital LOS, suggesting the need of optimizing hospital trajectories after ICU discharge.     

The role of transport intervals in outcomes for critically ill patients who are transferred to referral centers

Purpose

The aim of this study was to determine the association between transport intervals (including time from call to arrival of transport team at the sending hospital, time spent by the transport team in the sending hospital, and transport time between the sending and receiving hospital) and intensive care unit (ICU) and hospital length of stay and hospital mortality at the receiving hospital.

Materials and Methods

This was a retrospective, stratified cohort study involving all patients 15 years and older who were transferred from one hospital to another of equal or larger size in British Columbia, Canada, and who spent at least 1 day in an ICU or coronary care unit (CCU) at the receiving hospital during 1999 (n = 1930). Data were obtained from 6 administrative databases and linked using generalized software.

Results

After adjustment for age, sex, comorbidity, and diagnostic group, longer time from call to arrival of paramedics at the sending hospital was associated with a shorter length of ICU/CCU stay (rate ratio [RR], 0.91; 95% confidence interval [CI], 0.86-0.97) for survivors and a longer length of hospital (RR, 1.12; 95% CI, 1.05-1.21) and ICU/CCU (RR, 1.14; 95% CI, 1.04-1.25) stay for nonsurvivors in the higher-priority air transport group, and with a slightly shorter length of hospital stay (RR, 0.97; 95% CI, 0.95-0.99) for all patients in the lower-priority air transport group. Longer time spent by paramedics at the sending hospital was associated with a shorter length of hospital stay (RR, 0.79; 95% CI, 0.65-0.96) for survivors in the higher-priority air transport group. Longer time for transport between the sending and receiving hospitals was associated with a longer length of ICU/CCU stay (RR, 1.69; 95% CI, 1.26-2.27) for survivors in the higher-priority air transport group but a slightly shorter length of ICU/CCU stay (RR, 0.97; 95% CI, 0.95-0.99) for all patients in the ground transport group. There were no associations between transport times and hospital mortality.

Conclusions

Transport intervals are independently associated with ICU/CCU and hospital lengths of stay at the receiving hospital for critically ill adults transferred to referral centers.     

The role of Botulinum toxin injection in achieving balanced muscle function

Purpose.?The aim of this study was to explore the perceptions of adults with cerebral palsy and complex communication needs (CCN) on the roles and needs of their family carers in hospital.

Method.?As part of a larger study we conducted one focus group with six adults with cerebral palsy and CCN who participated in the group using a variety of augmentative and alternative communication methods.

Results.?Participants explored why and how family carers become involved in care in hospital, what this care involves, and how this impacts upon themselves as patients and on their family carers. Reasons underlying their dependence upon family carers during a hospital stay were outlined, particularly the carer's role in communication, information exchange and access to essential daily care. Strategies to improve the experience for family carers in hospital were discussed.

Conclusion.?Involvement of family carers of people with cerebral palsy and CCN during an inpatient hospital stay is complex. Although they depend upon others for communication support, these individuals with CCN wish to be treated as adults in hospital and included in decisions about their healthcare. They want to be involved in the education of hospital staff, and to communicate directly with hospital staff.     

The impact of implementing a rapid response system: A comparison of cardiopulmonary arrests and mortality among four teaching hospitals in Australia

Aims

To compare clinical outcomes between a teaching hospital with a mature rapid response system (RRS), with three similar teaching hospitals without a RRS in Sydney, Australia.

Methods

For the period 2002–2009, we compared a teaching hospital with a mature RRS, with three similar teaching hospitals without a RRS. Two non-RRS hospitals began implementing the system in 2009 and a third in January 2010. We compared the rates of in-hospital cardiopulmonary arrest (IHCA), IHCA-related mortality, overall hospital mortality and 1-year post discharge mortality after IHCA between the RRS hospital and the non-RRS hospitals based on three separate analyses: (1) pooled analysis during 2002–2008; (2) before–after difference between 2008 and 2009; (3) after implementation in 2009.

Results

During the 2002–2008 period, the mature RRS hospital had a greater than 50% lower IHCA rate, a 40% lower IHCA-related mortality, and 6% lower overall hospital mortality. Compared to 2008, in their first year of RRS (2009) two hospitals achieved a 22% reduction in IHCA rate, a 22% reduction in IHCA-related mortality and an 11% reduction in overall hospital mortality. During the same time, the mature RRS hospital showed no significant change in those outcomes but, in 2009, it still achieved a crude 20% lower IHCA rate, and a 14% lower overall hospital mortality rate. There was no significant difference in 1-year post-discharge mortality for survivors of IHCA over the study period.

Conclusions

Implementation of a RRS was associated with a significant reduction in IHCA, IHCA-related mortality and overall hospital mortality.     

Length of stay as risk factor for inappropriate hospital days: interaction with patient age and co‐morbidity

Rationale, aims and objectives The likelihood of a hospital day being inappropriate depends on patient characteristics, on the organization of in‐hospital care and on the co‐ordination between hospital care and the rest of the health care sector. The aim of the study was to assess if certain socio‐demographic and medical factors affect inappropriate hospital stay including possible interactions between age and co‐morbidity. Methods To determine the appropriateness of length of hospitalization, a prospective study was carried out using the European version of the Appropriateness Evaluation Protocol (AEP). A total of 438 hospital days of stay was analysed in medical wards of a university‐affiliated teaching hospital in the North of Italy for 3 days in September 2010. Results 44.6% of hospitalization days were classified as inappropriate. Unjustified hospital use was more frequent in patients whose hospital length of stay exceeded 10 days. Age and co‐morbidity were not per se risk factors for inappropriateness; however, in young patients hospitalized for more than 10 days, absence of chronic illness was a predictor. Conservative patient management, lack of discharge planning and delays in scheduling diagnostic tests or therapeutic interventions were the most common causal or contributory doctor‐ and hospital‐related factors. Conclusions Doctor attitudes and hospital organization are still among the most common reasons for inappropriate in‐hospital days of care. Monitoring whether the length of stay is appropriate combined with protocol interventions for scheduling of diagnosis, treatment and discharge are likely to improve efficiency in this area of medical care.     

Impact of an interprofessional transition of care service on 30-day hospital reutilizations

The objective of this study was to evaluate the impact of an interprofessional Transitions of Care (TOC) service on 30-day hospital reutilization inclusive of hospital readmissions and ED visits. This was a retrospective cohort study including patients discharged from an academic medical center between September 2013 and October 2014. Patients scheduled for a hospital follow-up visit in the post-acute care clinic (PACC) were included in the intervention group and patients without a post-discharge interprofessional TOC service were included in the comparison group. The intervention included a hospital follow-up visit with an interprofessional healthcare team. The primary composite outcome was hospital reutilization, defined as a hospital readmission or ED visit within 30 days of the discharge date. Overall, 330 patients were included in each group. In the intention-to-treat analysis, the primary composite outcome was not significantly different between groups (16.97% vs. 19.39%, P = 0.4195) whereas in the per-protocol analysis (all patients who showed to their PACC appointment), the primary outcome was significantly different in favor of the intervention group (9.28% vs. 19.39%, P = 0.0009). When components were analyzed separately, there was a statistically significant difference in favor of intervention group for hospital readmissions, but there was no difference for ED visits. This study demonstrates that an outpatient interprofessional TOC service with patient engagement from a team of nurses, pharmacists, physicians, and social workers may reduce 30-day hospital readmissions but may not impact 30-day ED visits.     

Guidelines for the clinical use of albumin: comparison of use in two Italian hospitals and a third hospital without guidelines

Background

In the absence of clinical practice guidelines prior to 1999, the consumption of human albumin in the Liguria region of Italy was very high, despite possible adverse effects, limited supply, and significant cost.

Objective

The purpose of this study was to assess the impact of comprehensive guidelines on the amount of albumin used in 2 general hospitals and to compare it with that of a third general hospital that did not adopt the guidelines.

Methods

We analyzed the influence of the guidelines on albumin use in 2 general hospitals (hospitals 1 and 2) in the Liguria region by comparing albumin consumption during the year before the distribution of the guidelines (1999) with consumption in the 2 years after their distribution (2000 and 2001). We compared these data with those of a third general hospital that did not adopt the guidelines (hospital 3). The parameters considered were total consumption of albumin, consumption per bed, consumption per hospital stay, mean time to discharge, expenditure per bed, and mortality rate.

Results

In the years 2000 and 2001, the adoption of guidelines reduced albumin consumption in hospitals 1 and 2. In hospital 1, where the release of albumin was carefully controlled by the transfusion service, albumin use per hospital stay decreased 8.7% in 2000 and 7.6% in 2001 from 1999; in hospital 2, use decreased 73.8% and 77.4%, respectively, from 1999. In hospital 3, rejection of the guidelines was coupled with an increase of 2.9% and 8.4%, respectively, in the amount of albumin used per hospital stay. In the years 2000 and 2001, the savings in the expenditure for albumin was ∼17,000 euro in hospital 1 and ∼200,000 euro in hospital 2.

Conclusion

This study confirms that the adoption of guidelines may substantially reduce the inappropriate use of albumin and relative costs.