一例迟发性产后子痫的诊治

先兆子痫和子痫在孕妇中发病率为6%～8%。1992年英国子痫研究组确诊了383例子痫病例,并提出子痫状态的严重后果应引起重视。1997年Leitch等指出在过去的60多年里,尽管产后子痫发病率有所升高,但子痫的发病率已经从74/10000降到了7.4/10000。美国一项研究在1992～2002年间确诊了229例产后先兆子痫或子痫,151例是因产后出现新的症状或体征再次入院后诊断的,其中16%的人(24/151)出现子痫。美国另一项研究在1996～2001年确诊了89例子痫,其中29例(33%)在产后出现子痫。这两项研究中大多数的病例症状出现在产后48小时以后。大多数产前或产时子痫…     

Stimulation of matrix formation in rabbit chondrocyte cultures by ascorbate. 2. Characterization of proteoglycans

The effect of ascorbate on the proteoglycans synthesized by rabbit articular chondrocytes was studied in first- and third-passage cultures for 12 and 26 days total duration, respectively. L-Ascorbate (0.2 mM) was added daily to half of the flasks after attachment of the cells. The cultures were labeled with Na2[35S]O4 or [14C]-glucosamine and [3H]-proline. Proteoglycans were isolated from the media and pericellular matrices by dissociative extraction and associative density gradient centrifugation. There was a large decline in the amount of proteoglycan synthesized between early and late cultures. Ascorbate increased the DNA content, amount of radiosulfate incorporated into glycosaminoglycans per microgram of DNA, and the proportion of labeled proteoglycan in the pericellular fraction of both short- and long-term cultures. The proteoglycans of the media and matrices of all cultures, with and without ascorbate, eluted as aggregates under associative column chromatographic conditions. The proteoglycans of 26-day cultures exhibited a higher degree of polydispersity in size than those of the short-term culture and contained small amounts of keratan (2-5%) and dermatan sulfate (4-8%) as assessed by keratanase and chondroitinase digestions, respectively. The effect of ascorbate, therefore, was to increase the amount of proteoglycan formed and to direct it into matrix deposition rather than to alter its quality.     

A comparison of patient dosage deviation reports with pill counts

Summary This is a report of a comparison between patient verbal reports of dosage deviation during a drug study and pill counts. Pill counts are much more reliable, but verbal reports are of some value, since when there are statements of major deviations they tend to be correct.This study was supported partly by United States Public Health Service Grants Number M 3741A and MYP 04732.     

Patient preferences for anesthesia outcomes associated with cesarean delivery

When deciding on neuraxial medication (e.g., spinal opioids) for cesarean delivery (CS) under regional anesthesia, anesthesiologists make treatment decisions that "trade off" relieving pain with the potential for increased risk of side effects. No previous studies have examined obstetric patients' anesthesia preferences. Researchers administered 100 written surveys to pregnant women attending our institutions' expectant parent class. We determined patients' preferences for importance of specific intraoperative and postoperative anesthesia outcomes using priority ranking and relative value scales. We also explored patients' fears, concerns, and tolerance regarding CS and analgesics. Eighty-two of 100 surveys were returned and analyzed. Pain during and after CS was the greatest concern followed by vomiting, nausea, cramping, pruritus, and shivering. Ranking and relative value scores were closely correlated (R2 = 0.7). Patients would tolerate a visual analog pain score (0-100 mm) of 56 +/- 22 before exposing their baby to the potential effects of analgesics they receive. In contrast to previous general surgical population surveys that found nausea and vomiting as primary concerns, we found pain during and after CS as parturients' most important concern. Common side effects such as pruritus and shivering caused only moderate concern. This information should be used to guide anesthetic choices, e.g., inclusion of spinal opioids given in adequate doses. IMPLICATIONS: Medical care can be improved by incorporating patients' preferences into medical decision making. We surveyed obstetric patients to determine their preferences regarding potential cesarean delivery anesthesia outcomes. Unlike general surgical patients who rate nausea and vomiting highest, parturients considered pain during and after cesarean delivery the most important concern.     

American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force

BACKGROUND: The American Pain Society (APS) set out to revise and expand its 1995 Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer Pain and to facilitate improvements in the quality of pain management in all care settings. METHODS: Eleven multidisciplinary members of the APS with expertise in quality improvement or measurement participated in the update. Five experts from organizations that focus on health care quality reviewed the final recommendations. MEDLINE and Cumulative Index to Nursing and Allied Health Literature databases were searched (1994-2004) to identify articles on pain quality measurement and quality improvement published after the development of the 1995 guidelines. The APS task force revised and expanded recommendations on the basis of the systematic review of published studies. The more than 3000 members of the APS were invited to provide input, and the 5 experts provided additional comments. The task force synthesized reviewers' comments into the final set of recommendations. RESULTS: The recommendations specify that all care settings formulate structured, multilevel systems approaches (sensitive to the type of pain, population served, and setting of care) that ensure prompt recognition and treatment of pain, involvement of patients and families in the pain management plan, improved treatment patterns, regular reassessment and adjustment of the pain management plan as needed, and measurement of processes and outcomes of pain management. CONCLUSION: Efforts to improve the quality of pain management must move beyond assessment and communication of pain to implementation and evaluation of improvements in pain treatment that are timely, safe, evidence based, and multimodal.