我国患者安全与医疗质量评价指标体系的循证分析研究

目的:分析2007年以来国内外有关患者安全与医疗质量评价指标的引用情况,为首都医科大学附属北京儿童医院患者安全与医疗质量评价指标体系的构建提供借鉴。方法:采用循证分析的方法对搜集到的367篇中英文文献进行分析。结果:最终纳入146篇文献,中文文献132篇,共提取150项指标,总引用频次≥10的指标共27项;英文文献14篇,共提取34项指标,总引用频次≥5的指标共16项。结论:各级医疗机构应加大对患者安全的关注,规范指标的应用,学会善于使用负向指标,不断拓宽患者安全指标的涵盖广度。     

医学教育虚拟学习社区个性化服务的实现

分析了医学教育虚拟社区的研究现状,以医学在线开放式学习平台——医学教育虚拟社区的"基础医学教学资源网"为例,从个性化学习资源和个性化学习平台两个方面入手,探讨了学习资源在虚拟学习社区内的个性化服务的实现。     

Changes in Weight Associated With Telotristat Ethyl in the Treatment of Carcinoid Syndrome

Purpose

In the placebo-controlled Phase III TELESTAR (Telotristat Etiprate for Somatostatin Analogue Not Adequately Controlled Carcinoid Syndrome) trial, the oral tryptophan hydroxylase inhibitor telotristat ethyl significantly reduced bowel movement (BM) frequency during a 12-week, double-blind treatment period in 135 patients with metastatic neuroendocrine tumors with carcinoid syndrome and ≥4 BMs per day. Patients (mean [SD] age, 63.5 [8.9] years; mean [SD] body mass index, 24.9 [4.9] kg/m²) received placebo, telotristat ethyl 250 mg, or telotristat ethyl 500 mg 3 times per day (TID) in addition to somatostatin analogue therapy. Weight loss is associated with uncontrolled carcinoid syndrome and may be associated with reduced survival.

Terlipressin versus norepinephrine as infusion in patients with septic shock: a multicentre,randomised, double-blinded trial

Purpose

Recent clinical data suggest that terlipressin, a vasopressin analogue, may be more beneficial in septic shock patients than catecholamines. However, terlipressin’s effect on mortality is unknown. We set out to ascertain the efficacy and safety of continuous terlipressin infusion compared with norepinephrine (NE) in patients with septic shock.

Methods

In this multicentre, randomised, double-blinded trial, patients with septic shock recruited from 21 intensive care units in 11 provinces of China were randomised (1:1) to receive either terlipressin (20–160 µg/h with maximum infusion rate of 4 mg/day) or NE (4–30 µg/min) before open-label vasopressors. The primary endpoint was mortality 28 days after the start of infusion. Primary efficacy endpoint analysis and safety analysis were performed on the data from a modified intention-to-treat population.

Results

Between 1 January 2013 and 28 February 2016, 617 patients were randomised (312 to the terlipressin group, 305 to the NE group). The modified intention-to-treat population comprised 526 (85.3%) patients (260 in the terlipressin group and 266 in the NE group). There was no significant difference in 28-day mortality rate between the terlipressin group (40%) and the NE group (38%) (odds ratio 0.93 [95% CI 0.55–1.56]; p?=?0.80). Change in SOFA score on day 7 was similar between the two groups: ??7 (IQR ??11 to 3) in the terlipressin group and ??6 (IQR ??10 to 5) in the NE group. There was no difference between the groups in the number of days alive and free of vasopressors. Overall, serious adverse events were more common in the terlipressin group than in the NE group (30% vs 12%; p?<?0.001).

Conclusions

In this multicentre, randomised, double-blinded trial, we observed no difference in mortality between terlipressin and NE infusion in patients with septic shock. Patients in the terlipressin group had a higher number of serious adverse events.

Trial registration

This trial is registered at ClinicalTrials.gov: ID NCT01697410.

     

Floating right heart thrombi: A pooled analysis of cases reported over the past 10 years

Introduction

Floating right heart thrombi (FRHTS) are a rare phenomenon associated with high mortality. Immediate treatment is mandatory, but optimal therapy is controversial.

The HAS-Choice study: Utilizing the HEART score,an ADP,and shared decision-making to decrease admissions in chest pain patients

Objective

The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol (ADP), and shared decision-making using a visual aid in the evaluation of chest pain patients. We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) setting while maintaining safe patient care.

301例慢性乙型肝炎病毒感染者血清学指标与肝脏组织病理的 相关性分析

目的 分析慢性乙型肝炎病毒（hepatitis B virus, HBV）感染者常用的血清学指标与肝脏病理的相关性。方法 纳入HBV感染者〔乙肝表面抗原（HBsAg）阳性或乙肝病毒载量（HBV DNA）持续阳性超过6个月〕301例,进行肝穿刺病理检查,病理组织学诊断按炎症活动度分5级(G0~G4)、纤维化分5期(S0~S4);常规血清生化检查：包括血清丙氨酸转移酶（ALT）、门冬氨酸转移酶（AST）、白蛋白（ALB）、球蛋白（GLB）、AST/ALT和白、球蛋白比值（A/G）;并进行HBV DNA和HBV基因型检测,分析各检测指标与病理炎症活动度分级及纤维化分期的相关性。 结果 ALT、AST水平和AST/ALT比值G2/G（3+4）组高于G0/G1组（P<0.05）,与肝脏炎症分级呈正相关（r分别为0.487,0.648,0.509,P<0.05）;GLB水平S2/S（3+4）组高于S0/S1组（P<0.05）,与肝脏纤维化分期呈正相关（r=0.674, P<0.05）。A/G水平S2/S（3+4）组低于S0/S1组（P<0.05）,与肝脏纤维化分期呈负相关（r=-0.500, P<0.05）。基因C型的HBV感染者的炎症及纤维化程度高于基因B型者（χ²分别为11.460和12.729,P<0.05）。结论 ALT、AST水平和AST/ALT比值对G2及以上的肝脏炎症、GLB和A/G对S2及以上的肝脏纤维化有较好的诊断价值,基因C型的HBV感染者较基因B型者病情进展相对更快。     

2011年-2013年某院清洁切口手术围手术期抗菌药物使用分析

目的评价通过采取多种管理手段对清洁切口手术围手术期抗菌药物使用合理性的影响。方法通过强化医生培训、加强医院感染管理、加大质控力度等多项措施进行控制管理。结果抗菌药物使用率从43.62%下降到19.6%,品种选择合理率从80.66%上升到97.63%;术前合理使用率从91.7%上升到98.83%;疗程合理率从77.73%上升到98.83%;杜绝了两种及以上抗菌药物联合用药作为预防使用。结论通过有效的管理手段可以规范围手术期的抗菌药物使用,保障患者安全。