A pilot randomized trial comparing symptomatic vs. hemoglobin-level- driven red blood cell transfusions following hip fracture

BACKGROUND: The indications for transfusion have never been evaluated in an adequately sized clinical trial. A pilot study was conducted to plan larger clinical trials. STUDY DESIGN AND METHODS: Hip fracture patients undergoing surgical repair who had postoperative hemoglobin levels less than 10 g per dL were randomly assigned to receive 1) symptomatic transfusion: that is, transfusion for symptoms of anemia or for a hemoglobin level that dropped below 8 g per dL or 2) threshold transfusion: that is, patients receive 1 unit of packed RBCs at the time of random assignment and as much blood as necessary to keep the hemoglobin level above 10 g per dL. Outcomes were 60-day mortality, morbidity, functional status, and place of residence. RESULTS: Among 84 eligible patients enrolled, mean (± SD) prerandomization hemoglobin was 9.1 (± 0.6) g/ dL. The median number of units transfused in the threshold transfusion group was 2 (interquartile range, = 1–2), and that in the symptomatic transfusion group was 0 (6; interquartile range, = 0–2) (p < 0.001). Mean hemoglobin levels were approximately 1 g per dL higher in the threshold group than in the symptomatic group: for example, on Day 2, 10.3 (± 0.9) g per dL versus 9.3 (± 1.2) g per dL, respectively (p < 0.001). At 60 days, death or inability to walk across the room without assistance occurred in 16 (39.0%) of the symptomatic transfusion group and 19 (45.2%) of the threshold transfusion group. Death occurred by 60 days in 5 (11.9%) of the symptomatic transfusion group and 2 (4.8%) in the threshold transfusion group (relative risk = 2.5; 95% CI, 0.5–12.2). Other outcomes were similar for the two groups. CONCLUSIONS: Symptomatic transfusion may be an effective blood-sparing protocol associated with the transfusion of appreciably fewer units of RBCs and lower mean hemoglobin levels than are associated with the threshold transfusion policy. However, it is unknown whether these two clinical strategies have comparable mortality, morbidity, or functional status. A definitive trial is needed.     

微创髋关节置换术治疗老年股骨颈骨折的临床疗效

目的探讨微创髋关节置换术治疗老年股骨颈骨折临床疗效。方法选择本院2009年3月至2012年3月髋关节置换术手术患者100例,随机分为观察组和对照组,观察组行微创髋关节置换术,对照组行常规人工髋关节置换术。记录两组患者手术时间、手术出血量及切口长度,对两组患者术后随访进行Harris评分并进行对比。结果观察组切口长度、手术出血量分别与对照组比较,差异有统计学意义(P<0.05),手术时间较对照组无差别(P>0.05);两组患者术后评分比较,3个月前差异有统计学意义(P<0.05),3个月后差异无统计学意义(P>0.05)。结论微创髋关节置换术治疗老年股骨颈骨折具有手术出血少,创伤小,术后早期功能恢复快,并发症少,临床疗效好,值得临床推广。     

Rallying the Troops: A Four-Step Guide to Preparing a Residency Program for Short-Term Weather Emergencies

Background: Weather emergencies present a multifaceted challenge to residents and residency programs. Both the individual trainee and program may be pushed to the limits of physical and mental strain, potentially jeopardizing core competencies of patient care and professionalism. Although daunting, the task of preparing for these events should be a methodical process integrated into every residency training program. Summary: The core elements of emergency preparation with regard to inpatient services include identifying and staffing critical positions, motivating residents to consider the needs of the group over those of the individual, providing for basic needs, and planning activities in order to preserve team morale and facilitate recovery. The authors outline a four-step process in preparing a residency program for an anticipated short-term weather emergency. An example worksheet for emergency planning is included. Conclusion: With adequate preparation, residency training programs can maintain the highest levels of patient care, professionalism, and esprit de corps during weather emergencies. When managed effectively, emergencies may present an opportunity for professional growth and a sense of unity for those involved.     

儿童保健教学中学生评价的实施与思考

学生评价是教学过程的重要组成部分。重庆医科大学儿童保健学教研室结合学科实际情况,关注个体儿童生长发育及群体儿童整体发展的特点,在课堂教学、临床实习过程中,合理应用终结性评价和形成性评价,保持学生的学习兴趣,促进知识掌握,提高临床技能,保证课程教学目标顺利完成,同时促进教师教学水平的提高。     

改良烧伤烤架在烧伤患者暴露疗法中的应用

目的　观察改良烧伤烤架在烧伤患者暴露疗法中的应用效果。方法　将160 例患者按病历号的奇偶数随机分成实验组和对照组, 实验组应用改良的烧伤烤架, 对照组应用传统的烧伤烤架, 对两组患者的治疗效果、安全性、满意度等方面进行评价。结果　两组患者的治疗效果无差异, 改良的烧伤烤架安全性好、患者满意度高。结论　改良的烧伤烤架对患者治疗效果没有影响, 可减少成本支出, 同时能保障患者安全, 提高患者对医护人员的满意度, 简便实用易于推广。     

PIGMENTED MACULES ON PALMS AND SOLES IN PUERTO RICANS

Background. One-third of melanomas in Puerto Ricans occur on the skin of palms and soles. This is a study to define the characteristics of melanocytic nevi in those locations. Background. One-third of melanomas in Puerto Ricans occur on the skin of palms and soles. This is a study to define the characteristics of melanocytic nevi in those locations. Methods. A sample of 1,039 patients were randomly examined for pigmented macules on the palms and soles. After informed consent, biopsies of these lesions were done on 67 patients. Results. Among the patients, 13% were found to have pigmented macules on the palms and soles. Volar melanocytic macule was the most frequent lesion. Conclusions. Melanocytic nevi occur frequently on volar skin. The criteria for removal of these lesions should not be different from those lesions at other locations.