David Sackett:循证医学之父

David Sackett教授是具有批判性思维、以革新传统医学模式为志业的医生科学家。他致力于发展和推广临床流行病学和循证医学, 一生桃李满天下, 完全符合中国传统文化对于"师"的定义。其主要贡献包括:(1)率先将临床流行病学方法应用于医疗实践, 奠定了循证医学的理论基础和学科框架; (2)分别在加拿大麦克马斯特大学和英国牛津大学建立临床流行病学中心, 培养了大批人才; (3)使循证医学成为临床研究和实践必须遵循的规范, 从而深刻改变了现代医学的面貌。David Sackett教授和中国学者联系密切, 为我国临床研究和循证医学事业奠定了基础。     

A Portrait History of Cardiology

Duodenal ulcer which occurs in childhood does not always respond satisfactorily to medical therapy.

A study of 109 patients at the Mayo Clinic showed that there is a 50 per cent chance that duodenal ulcer which begins in childhood will persist or recur in adolescence or adulthood if medical treatment alone is employed.

The authors present a study of 10 children who had surgical treatment for duodenal ulcer after medical measures had failed. Five patients had a posterior gastroenterostomy and five had a gastric resection. There were no surgical deaths, and eight traced patients developed normally without recurrence of ulcer.     

Werner综合征伴发脑膜瘤患者一例的护理

Werner综合征（Werner syndrome,WS）又称成人早老综合征（adult progeria）、成人早衰老综合征（adult premature aging syndrome）,是一种罕见的常染色体隐性遗传性疾病。WS多发于青春期,寿命常在40岁左右,而伴发脑膜瘤的WS病例更为罕见报道,在我国尚无报道。我科于2008年3月收治1例伴发颅内海绵窦斜坡脑膜瘤的WS患者,     

Improving Throughput in Interventional Radiology: A Team Collaboration

The project purpose was to reduce patient throughput to 15:00 minutes or less once the patient arrived in interventional radiology (IR). Ishikawa (fishbone) diagram and Plan-Do-Study-Act test of change scientific methodology were used. Baseline data, specifically the time the patient arrived to the holding area to the time the patient was ready to begin the procedure was collected. Focus groups, through brainstorming, provided fishbone categories and causes leading to delayed throughput. Kotter's (2019) eight-step process of creating change was used to transform the team and execute the change. Over 10 months, between August 2017 and June 2018, data for start time were tracked for 1188 inpatients procedures and 1708 outpatient procedures. Overall time reduction from a mean time of 25:30 minutes to a mean of 15:00 minutes was achieved for all cases. A new model of care delivery realigned IR roles and created a structured process, improving interprofessional members' communication of pertinent patient safety information. Creating and implementing a new care delivery model based on interprofessional collaboration can be accomplished without increasing the number of physician providers, IR technologists, RNs, or support staff. The decreased throughput time was directly influenced by realigning staff roles and responsibilities and creation of the charge nurse role.     

Interventional treatments for hepatic hemangioma: A state-of-the-art review

Hepatic hemangiomas (HHs) are the most common benign tumors of the liver. These tumors are mainly asymptomatic and do not require treatment. Nevertheless, there are some special cases that require therapeutic intervention, and surgery and intervention are currently the primary treatment modalities. Despite significant advances in the development of minimally invasive techniques and their popularization, interventional treatment of HH is still the preferred choice. In the present review, we discuss the pathological properties, type of blood supply, and treatment indications for HH and assess the status and progress of the existing interventional treatments.     

Antibiotic Use in Interventional Radiology: A Nursing Perspective

Bacteria can produce illness and result in debilitating disease and death. Normal residential flora that inhabit the body surface may have access to body organs and systems through interventional radiology procedures. Antibiotics may be given in an effort to reduce potential infectious processes. Nursing management should include self-awareness, knowledge of procedures and complications, patient and family education, and management of the environment. It is important for nurses to be intrinsically knowledgeable and play a significant part of infection prevention for patients undergoing invasive procedures.     

Advances in Clinical Cardiology 2017: A Summary of Key Clinical Trials

Introduction

Numerous important cardiology clinical trials have been published or presented at major international meetings during 2017. This paper aims to summarize these trials and place them in clinical context.

Methods

The authors reviewed clinical trials presented at major cardiology conferences during 2017 including the American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, European Society of Cardiology, European Association for the Study of Diabetes, Transcatheter Cardiovascular Therapeutics, and the American Heart Association. Selection criteria were trials with a broad relevance to the cardiology community and those with potential to change current practice.

Results

A total of 75 key cardiology clinical trials were identified for inclusion. New interventional and structural cardiology data include left main bifurcation treatment strategy, multivessel disease management in cardiogenic shock, drug-eluting balloons for in-stent restenosis, instantaneous wave-free physiological assessment, new-generation stents (COMBO, Orsiro), transcatheter aortic valve implantation, and closure devices. New preventative cardiology data include trials of liraglutide, empagliflozin, PCSK9 inhibitors (evolocumab and bococizumab), inclisiran, and anacetrapib. Antiplatelet data include the role of uninterrupted aspirin therapy during non-cardiac surgery and dual antiplatelet therapy following coronary artery bypass grafting. New data are also included from fields of heart failure (levosimendan, spironolactone), atrial fibrillation (apixaban in DC cardioversion), cardiac devices (closed loop stimulation pacing for neuromediated syncope), and electrophysiology (catheter ablation for atrial fibrillation).

Conclusion

This paper presents a summary of key clinical cardiology trials during the past year and should be of practical value to both clinicians and cardiology researchers.

     

Conversations on Dying: A Palliative Care Pioneer Faces His Own Death

The journal is delighted to continue a collaboration with the International Association for Hospice and Palliative Care (IAHPC) in publication of book reviews relevant to symptom control in advanced disease. These reviews are adapted from the work of Roger Woodruff, MD, FRACP, FAChPM, an internationally recognized oncologist and palliative care specialist physician from Australia. Dr. Woodruff's reviews appear concurrently or did so previously in the IAHPC Newsletter, which is accessible through the IAHPC Web site: http://hospicecare.com.