Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team

Introduction  

In order to minimize the additional risk of interhospital transport of critically ill patients, we started a mobile intensive care unit (MICU) with a specialized retrieval team, reaching out from our university hospital-based intensive care unit to our adherence region in March 2009. To evaluate the effects of this implementation, we performed a prospective audit comparing adverse events and patient stability during MICU transfers with our previous data on transfers performed by standard ambulance.     

The real experience of patients after liver transplantation in intensive care unit

We aimed to explore the real experience of patients after liver transplantation in the intensive care unit (ICU).Objective sampling method was used to select patients transferred to the ICU in 10 hospitals in Zhuhai from May 2018 to August 2020. Patients need liver transplantation due to advanced liver cancer and decompensated cirrhosis. The eligibility criteria of patients mainly included liver transplant patients who were clear-minded and willing to participate in the study and had stayed in ICU. Phenomenological research methods and in-depth interviews were used in this qualitative study.The results showed that the true experience of patients after liver transplantation during ICU stay was summarized into four themes. The strengths of our qualitative research are that we can find the trend from a phenomenon through interviews and other methods to provide a directional foundation for future quantitative research. Its limitations are that it requires a lot of manpower and time, and its objectivity and universality are limited.Hospitalization experience in the ICU may lead to many negative experiences for liver transplant patients. Nurses should fully understand and pay attention to the psychological changes in patients. Nurses should take effective targeted measures to reduce or eliminate patients’ fear of ICU stay and promote rehabilitation.     

Dimensionality and scale properties of the Edinburgh Depression Scale (EDS) in patients with type 2 diabetes mellitus: the DiaDDzoB study

Background

Depression is a common complication in type 2 diabetes (DM2), affecting 10-30% of patients. Since depression is underrecognized and undertreated, it is important that reliable and validated depression screening tools are available for use in patients with DM2. The Edinburgh Depression Scale (EDS) is a widely used method for screening depression. However, there is still debate about the dimensionality of the test. Furthermore, the EDS was originally developed to screen for depression in postpartum women. Empirical evidence that the EDS has comparable measurement properties in both males and females suffering from diabetes is lacking however.

Methods

In a large sample (N = 1,656) of diabetes patients, we examined: (1) dimensionality; (2) gender-related item bias; and (3) the screening properties of the EDS using factor analysis and item response theory.

Results

We found evidence that the ten EDS items constitute a scale that is essentially one dimensional and has adequate measurement properties. Three items showed differential item functioning (DIF), two of them showed substantial DIF. However, at the scale level, DIF had no practical impact. Anhedonia (the inability to be able to laugh or enjoy) and sleeping problems were the most informative indicators for being able to differentiate between the diagnostic groups of mild and severe depression.

Conclusions

The EDS constitutes a sound scale for measuring an attribute of general depression. Persons can be reliably measured using the sum score. Screening rules for mild and severe depression are applicable to both males and females.     

环氧合酶抑制剂与心血管事件的发生和预防

2004年,罗非昔布（万络）因致心血管疾病风险而撤市。市场上能增加心血管疾病风险的相关药物和环氧合酶（COX-2）抑制剂以及非选择性非甾体抗炎药（NSAID）也遭到质疑。本文论述是否新的证据能改进现有的临床实践和监管条例。过多的抑制COX-2会增加心血管疾病的发生风险,除非同时对血小板血栓素合成的抑制达95%以上,这可通过全血分析检测。最近研究证实,对乙酰氨基酚（扑热息痛）也是一种COX-2选择性抑制剂。流行病学调查指出,对乙酰氨基酚作为一种易得的非处方药物,也存在增加心血管事件的风险。目前尚无足够证据认为罗非昔布的替代药品是安全的。对NSAID的药品监管及处方应遵循“首要不伤害”的预警性原则,药品应强制性加注此类药物心血管风险的告示,以警示处方者和患者。     

同型半胱氨酸—糖尿病血管病变的新型危险因素

同型半胱氨酸（Hcy）是蛋氨酸代谢中间产物,是一种含硫基的氨基酸。1964年Gibson等首先报道高同型半胱氨酸血症与血管性疾病和血栓形成相关,1969年Mcully提出Hcy可能与动脉粥样硬化有关。随着近30年的深入研究,众多资料表明高Hcy血症（hHcy）是心脑血管病变的一个独立危险因素。     

Effects of polychlorinated biphenyls (PCBs) on expression of neurotrophic factors in C6 glial cells in culture

Polychlorinated biphenyls (PCBs) are persistent environmental pollutants that affect nervous system function. Glial cells are among the first lines of defense in the nervous system and are involved in activities, including production of neurotrophic factors, which maintain an environment optimally suited for neuronal function. In this study, we investigated the effects of a commercial mixture of PCBs, Aroclor 1254 (A1254), on neurotrophic factor secretion by C6 cells in culture. C6 cells were exposed to medium containing 10 ppm A1254, 0.1% dimethyl sulfoxide (DMSO=vehicle), or normal culture medium. Glial cell line-derived neurotrophic factor (GDNF) and nerve growth factor (NGF) protein were measured by enzyme-linked immunosorbant assay. GDNF mRNA was measured by real-time RT-PCR. The role of protein kinase C (PKC) signaling in A1254 effects was investigated using bisindolylmaleimide, a PKC antagonist. Exposure to A1254 increased NGF (8.8x10(-5)+/-8.2x10(-6)pg NGF/cell) and GDNF (1.0x10(-4)+/-6.7x10(-6)pg GDNF/cell) secretion compared to DMSO treated controls (5.0x10(-5)+/-7.5x10(-6)pg NGF/cell and 6.2x10(-5)+/-3.1x10(-6)pg GDNF/cell). The effect of A1254 was long-lived, as GDNF secretion was elevated following 5 days of exposure (4.1x10(-5)+/-1.7x10(-6)pg GDNF/cell in A1254 exposed cells vs. 2.9x10(-5)+/-2.3x10(-6)pg GDNF/cell in DMSO exposed cells). GDNF mRNA expression was also elevated following exposure to A1254 (1.14+/-0.07 gene expression units in A1254 exposed cells vs. 0.8+/-0.07 gene expression units in DMSO exposed cells). Bisindolylmaleimide was able to block the effects of A1254 on GDNF secretion. Thus, one potential mechanism by which PCBs may alter nervous system function is via disruption of neurotrophic factor expression by glial cells. The observation that neurotrophic factor expression was increased following exposure to PCB may suggest that glial cells increase expression of neuroprotective genes following exposure to potentially damaging agents such as PCBs.     

The EndoAssist? Robotic Camera Holder as an Aid to the Introduction of Laparoscopic Colorectal Surgery

INTRODUCTION

Introducing laparoscopic colorectal surgery is a challenge to the whole surgical team. It is usual for an assistant to hold the laparoscope and be responsible for the surgeon''s view of the operative field and a lack of expertise in the assistant can add significant difficulties. The EndoAssist™ is a robotic device that replaces the human assistant and ensures steady visualisation of the operative field and a view which can be controlled by the surgeon. This study describes its use in the introduction of laparoscopic colorectal surgery to a unit.

PATIENTS AND METHODS

The EndoAssist was employed for the introduction of laparoscopic colorectal surgery in a unit with previous experience of this device for laparoscopic cholecystectomy. It was used in a consecutive series of 77 laparoscopic colectomy operations.

RESULTS

The robotic device proved successful in the whole range of colorectal operations and a reliable assistant. No problems specific to the device were encountered.

CONCLUSIONS

The EndoAssist robot is a useful laparoscopic assistant and aided in the introduction of laparoscopic colorectal surgery.