Switzerland has the reputation of having one of the best healthcare systems in the world. Aims, such as a high level of patient safety, efficiency and access to a high standard of healthcare are achieved for the majority of patients. According to public surveys patient expectations and satisfaction are met to a great extent but the service is costly, making it one of the most expensive healthcare systems in the world. More than 60?% of the expense is paid by private households. Since the introduction of the new Swiss diagnosis-related groups (DRG) finance system in 2012, there have been many economic changes putting more strain on the system. This poses the question of how resources and funds can be best implemented by nursing staff, to ensure high quality care and the best possible patient outcome. Flexibility, subspecialization of healthcare professionals, patients with multiple comorbidities and electronic documentation are discussed in a clinical example. In summary, a cost-efficient provision of nursing care is possible; however, demands have risen requiring a greater flexibility of nursing staff and more patient self-motivation. A significant proportion of nursing time is consumed with administrative work and electronic data management. This reduces the time available for direct patient care. New models of nursing care need to be explored and debated. 相似文献
Port-site metastases in gynecological malignancies subsequent to laparoscopy have been reported with an incidence of 1.1-16%. These metastases tend to be disappearing after primary debulking surgery and subsequent primary chemotherapy. Local resection, chemotherapy and/or radiotherapy have been defined in the management of these metastases with enhanced clinical success. However, in extremely rare cases these metastases were also defined very early during neoadjuvant chemotherapy. Herein, we present two ovarian cancer cases which are clinically diagnosed with port site metastasis during neoadjuvant chemotherapy following diagnostic laparoscopy. Although neoadjuvant chemotherapy is sometimes needed in cases of fully advanced ovarian cancers, port-site metastasis may be encountered during neoadjuvant chemotherapy. The possible poor prognosis of these patients, especially those who have ascites, should make us careful in performing diagnostic laparoscopy with preventive measures for port-site metastasis and to start the chemotherapy immediately. 相似文献
We report a case of severe subcapsular hepatic steatosis in a middle-aged woman with diabetic nephropathy requiring continuous ambulatory peritoneal dialysis (CAPD). The CT appearances of the liver were initially suspected to be due to embolic infarcts. However, an accurate diagnosis was made only after a history of intraperitoneal insulin administration was elicited, and this was confirmed on MRI with chemical shift gradient-echo pulse sequences. Haemodialysis was recommenced, and follow-up imaging 4 years later showed complete resolution of subcapsular hepatic steatosis.Subcapsular hepatic steatosis is a rare and unique form of non-alcoholic fatty liver, occurring only in individuals with diabetic nephropathy receiving continuous ambulatory peritoneal dialysis (CAPD) with intraperitoneal insulin. Imaging findings are classical, and with the appropriate history of intraperitoneal insulin administration, an accurate diagnosis can be made. Given that this disease entity has only recently been described, we hope to highlight its typical imaging appearances, which may otherwise be misinterpreted as a more insidious finding, thus averting unnecessary intervention. 相似文献
The aim of this study was to investigate the correlations between body segment movements and center of mass (COM) velocity during pathological balance corrections of spinocerebellar ataxia (SCA) patients compared with controls, and to relate correlations indicating instability to EMG activity differences. 相似文献
Tumor Treating Fields (TTFields), low intensity alternating electric fields with antimitotic activity, have demonstrated survival benefit in patients with glioblastoma. This phase 2 PANOVA study was conducted to examine the combination of TTFields plus chemotherapy in patients with pancreatic ductal adenocarcinoma (PDAC).
Methods
Forty patients with newly-diagnosed, locally advanced or metastatic PDAC received continuous TTFields (150?KHz for ≥18?h/day) plus gemcitabine (1000?mg/m2), or gemcitabine plus nab-paclitaxel (125?mg/m2). The primary endpoint was safety and secondary endpoints included compliance to TTFields, progression-free survival (PFS), and overall survival (OS).
Results
Seventeen patients (85%) in each cohort reported Grade ≥3 adverse events (AEs). No increase in serious AEs (SAEs) was observed compared to that anticipated with systemic chemotherapy alone. Twenty-one patients reported TTFields-related skin toxicity, of which 7 were Grade 3; all resolved following temporary reduction of daily TTFields usage. No TTFields-related SAEs were reported. Compliance to TTFields was 68–78% of the recommended average daily use in both cohorts. Median PFS was 8.3 months (95% CI 4.3, 10.3) and median OS was 14.9 months (95% CI 6.2, NA) in the TTFields + gemcitabine cohort. In the TTFields + gemcitabine + nab-paclitaxel cohort, the median PFS was 12.7 months (95% CI 5.4, NA); median OS has not been reached.
Conclusion
The PANOVA trial demonstrated that the combination of TTFields and systemic chemotherapy is safe and tolerable in patients with advanced PDAC. Based on the safety and preliminary efficacy results of this phase 2 study, a randomized phase 3 study (PANOVA-3) is underway. 相似文献
Metabolic Brain Disease - The gut microbiota influences brain development and functioning through the gut-brain axis. This is first study regulate maternal gut microbiota and fetal neurodevelopment... 相似文献
Aim: This study aims to research whether there is a relationship between first trimester nuchal translucency (NT) measurements and pregnancy complications such as gestational diabetes mellitus (GDM), gestational hypertension (GHT), intrauterine growth restriction (IUGR) and oligohydramnios.
Method: This study included 225 singleton pregnancies attending Canakkale Onsekiz Mart University Obstetrics and Gynecology clinic for all monitoring and examinations, and gave birth at our clinic between January 2011 and December 2012. Data sources were clinical records and the hospital's automation system, and the study was planned as retrospective cohort. NT measurement was made between 10 weeks 3 days and 13 weeks 6 days gestation. For data analysis, the chi-square, Mann–Whitney U test and Spearman correlation were used.
Results: Of pregnancies, in the study, 5 (2.2%) developed GDM, 6 (2.6%) developed GHT, 2 (0.89%) developed IUGR and 10 (4.4%) developed oligohydramnios. There was no correlation identified between NT measurements and development of GDM, GHT, IUGR and oligohydramnios.
Conclusion: There was no relationship found between first trimester NT measurements and complications that could develop in pregnancy. For the first time in the literature, NT and oligohydramnios were studied and no relationship was observed. 相似文献