A study of the effectiveness of performance-focused methodology for improved outcomes in Alberta public healthcare

This study evaluates the effectiveness of a performance-focused methodology for engaging multidisciplinary, frontline healthcare teams in making behavioural changes that improve patient care and health system efficiency. Results include significant declines in average length of stay in hospital and waiting time for surgery, and a dramatic increase in early patient ambulation. Performance-focused methodology using key performance indicators, targets, measurement, and ongoing feedback, supported by non-monetary incentives, can quickly improve healthcare outcomes.     

新疆维吾尔族成人支气管哮喘的影响因素研究

摘要:目的　探讨新疆乌鲁木齐市维吾尔族人群成人支气管哮喘的影响因素。方法　本研究采用成组匹配病例对照研究方法,病例组为新疆医科大学第一附属医院呼吸内科在2014年1-12月确诊的维吾尔族支气管哮喘成人患者（n＝120例）,对照组为同期体检中心健康维吾尔族体检者（n＝126例）,两组在年龄、性别相匹配。采用问卷调查的方法收集相关暴露资料,并采用单因素分析及多因素非条件Logistic回归模型分析成人支气管哮喘影响因素。结果　多因素Logistic回归分析显示,吸烟（OR＝1.88,95% CI:1.28～2.96）、家族支气管哮喘史（OR＝6.20,95% CI:2.10～18.31）、家中铺有纯毛地毯数量多（OR＝1.87,95% CI:1.18～2.95）,睡眠质量（OR＝1.46,95% CI:1.22～1.75）,患慢性支气管炎（OR＝13.43,95% CI:6.65～25.34）及过敏性鼻炎（OR＝6.27,95% CI:3.63～10.81）是维吾尔族成人支气管哮喘的主要影响因素。结论　维吾尔族成人支气管哮喘是生活方式、环境及遗传等多种因素共同作用的结果,应加强对相关影响因素的预防及治疗,减少哮喘的发生,改善哮喘患者生活质量。     

Incidence and prevalence of abnormal liver associated enzymes in patients with atrial fibrillation in a routine clinical care population

The prevalence of elevated liver enzymes has not been described in patients with atrial fibrillation (AF) who may be more likely to develop these abnormalities due to comorbidities and medications. As signals of liver injury lead to termination of drug development programs, an attempt to better define the background prevalence would aid in interpreting these elevations in the setting of exposure to a new drug. The aim of this study was to estimate the prevalence and incidence of alanine aminotransferase (ALT) elevations in a cohort with AF. METHODS: Retrospective cohort of patients with AF using the outpatient medical record of the University of Pennsylvania Health System (UPHS). Primary outcomes were prevalence and incidence of ALT elevations (>40 U/L). We also examined the prevalence of risk factors for ALT elevations. RESULTS: Liver enzymes were measured at least once in 1630 of 2151 patients (76%). The prevalence of ALT >40 U/L was 27.6% (95%CI 25.7-29.5%). The incidence of new ALT elevations was 14.5/100 person-years (95%CI 13.0-16.1) for ALT > 40 U/L and 2.1/100 person-years (95%CI 1.6-2.8) for ALT elevations above twice the upper limit of normal (ULN). New persistent ALT elevations above twice the ULN were identified in 0.2% of patients. CONCLUSION: Elevated ALT is common among patients with AF, although new and persistent elevation greater than twice the ULN is uncommon. In the setting of a new drug, these factors make it difficult to delineate drug-induced liver injury from incident elevations due to comorbidities.     

模拟后路椎间盘镜下腰椎间盘摘除术与传统术式治疗腰椎间盘突出症对腰椎生物力学稳定性的影响

目的探讨后路椎间盘镜下腰椎间盘摘除术(MED)及传统开放腰椎间盘摘除术对腰椎生物力学稳定性的影响。方法选用6具新鲜尸体脊柱标本,模拟后路腰椎间盘摘除的不同术式,依次对标本腰3～4间隙进行处理,共设计5种减压情况:MED、半椎板切除、半椎板切除并下关节突1/2切除、半椎板切除并下关节突全部切除和全椎板切除髓核摘除术。在力学实验机上分别对实验标本进行前屈/后伸、左/右侧屈及左/右轴向旋转运动,测量不同运动的最大范围。结果模拟MED手术脊柱标本向各个方向的运动与正常对照组比较差异无统计学意义(P>0.05);半椎板切除术、半椎板切除并下关节突1/2切除后,标本向各个方向的运动除半椎板切除并下关节突1/2切除后右侧旋转外与正常对照组差异无统计学意义(P>0.05),半椎板切除并下关节突全部切除后,标本向各个方向运动与正常对照组比较差异均有统计学意义(P<0.05,右侧旋转P<0.01);模拟全椎板切除标本向各个方向的运动与正常对照组比较差异均有统计学意义(P<0.01)。结论MED手术对脊柱破坏性较小,对稳定性无影响,而半椎板并小关节切除则破坏了稳定性。     

血府逐瘀汤对乳鼠心肌细胞缺血再灌注损伤的影响

目的为探讨血府逐瘀汤对乳鼠心肌细胞缺血再灌注损伤的影响。方法应用培养的乳鼠心肌细胞造成缺血再灌注损伤的动物模型,观察心肌细胞中超氧化物岐化酶(SOD)的水平,推断细胞内活性氧的生成量;观察培养液中乳酸脱氢酶(LDH)活性改变以判断细胞损伤情况;并进行DNA琼脂糖凝胶电泳及末端脱氧核苷酸介导的脱氧尿苷三磷酸缺口末端标记法(TUNEL),以判断细胞死亡类型及程度。结果血府逐瘀汤可显著升高缺血再灌注时SOD的水平,显著降低LDH的水平。DNA电泳图谱表明:血府逐瘀汤可使DNA的拖尾基本消失;TUNEL显示血府逐瘀汤可显著减少缺血再灌注所致的心肌细胞死亡。结论血府逐瘀汤有保护缺血再灌注时心肌细胞免于死亡之功效。     

Neu (C-erbB-2) Oncogene in Breast Cancer and its Possible Association with the Risk of Distant Metastases a Retrospective Study and Review of Literature

By immunohistochemical staining C-erbB-2 (neu) oncogene was found on the cell membrane in 19 out of 44 primary breast cancers from a pathology archive. No obvious relation was found between neu oncogene, age, and lymph node status and tumor size. There was a tendency towards smaller primary tumors and more estrogen receptor-negative tumors in the oncogene-positive group. No case of distant metastasis during follow-up was found among the oncogene-negative patients, while 6 oncogene-positive patients developed such metastases. This suggests that the neu oncongene is an independant prognostic factor, which might predict the development of distant metastasis. Further studies including more patients and long-term survival analysis are, however, needed in order to evaluate the prognostic significance of the neu oncogene.