Just-in-Time Evidence-Based E-mail “Reminders” in Home Health Care: Impact on Patient Outcomes

OBJECTIVE: To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients. DATA SOURCES/STUDY SETTING: Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF. STUDY DESIGN: Patients were treated by nurses randomly assigned to usual care or one of two intervention groups. The basic intervention was an e-mail to the patient's nurse highlighting six HF-specific clinical recommendations. The augmented intervention supplemented the initial nurse reminder with additional clinician and patient resources. DATA COLLECTION: Patient interviews were conducted 45 days post admission to measure self-management behaviors, HF-specific outcomes (Kansas City Cardiomyopathy Questionnaire-KCCQ), health-related quality of life (EuroQoL), and service use. PRINCIPAL FINDINGS: Both interventions improved the mean KCCQ summary score (15.3 and 12.9 percent, respectively) relative to usual care (p< or =.05). The basic intervention also yielded a higher EuroQoL score relative to usual care (p< or =.05). In addition, the interventions had a positive impact on medication knowledge, diet, and weight monitoring. The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes. CONCLUSIONS: This study demonstrates the positive impact of targeting evidence-based computer reminders to home health nurses to improve patient self-care behaviors, knowledge, and clinical outcomes. It also advances the field's limited understanding of the cost-effectiveness of selected strategies for translating research into practice.     

介入治疗下肢深静脉血栓的临床应用

目的 探讨介入治疗下肢深静脉血栓(deep venous thrombosis,DVT)的效果. 方法 38例DVT均行深静脉置管接触性溶栓,12例联合血管球囊扩张及血管内支架置入术.按我院疗效观察标准:治愈,造影检查示血栓完全溶解,静脉壁光滑;显效,静脉回流通畅,静脉内有附壁血栓,管腔内径≥2/3;有效,静脉内仍有血栓残留,管腔内径＜2/3;无效,造影检查示静脉回流不通畅. 结果 治愈22例,显效14例,有效2例.治疗中无严重并发症发生.34例随访3～24个月,其中3～6个月7例,7～12个月12例,13～24个月15例,血栓复发2例,经再次深静脉置管接触性溶栓治疗后部分再通. 结论 介入治疗DVT操作简便,安全有效.     

CT导向下经皮射频消融术治疗肾上腺恶性肿瘤

目的对29例肾上腺肿瘤患者行射频消融（RFA）治疗，研究其近期局部治疗效果、不良反应和副作用。方法肾上腺肿瘤患者共29例，病灶总数31个，其中直径≤2．0cm的病灶共5个，2．1-4．0cm者18个，4．1-6．0cm者5个，≥6．1cm者3个，经RFA治疗1个月后行螺旋CT双期增强扫描评价肿瘤治疗效果。结果上述病灶经消融治疗后达到完全坏死者分别为5个、18个、3个、2个。患者无严重并发症出现。结论RFA治疗安全可靠，副作用小，是治疗肾上腺恶性肿瘤的有效方法之一。     

多疗程治疗的癌症病人入院时的焦虑状态调查

[目的]了解恶性肿瘤病人反复多次入院治疗时的心理状态,通过护理干预帮助病人更快投入治疗情境.[方法]通过焦虑自评量表(SAS)进行心理测验,随机将病人分为对照组和实验组,针对结果分别进行相应护理,1周后复查.[结果]实验组和对照组护理后的SAS评分差异显著.[结论]癌症病人多疗程入院的病人焦虑状况严重,实施焦虑的支持护理及心理辅助,可较好地促进病人进入治疗角色,减少弃治轻生的发生.     

脑源性神经生长因子和神经干细胞联合移植对大脑中动脉阻塞大鼠神经功能恢复的作用

目的 将脑源性神经生长因子(BDNF)和神经干细胞(NSCs)单独及联合移植应用于大脑中动脉阻塞(MCAo)模型大鼠,观察BDNF和NSCs移植对大鼠缺血性脑卒中神经功能恢复的作用及BDNF对内源性和外源性NSCs增殖、迁移及分化的影响.方法 体外分离、培养新生大鼠海马NSCs,BrdU标记.实验动物随机分为A组(MCAo组);B组(MCAo+BDNF组);C组(MCAo+NSCs组);D组(MCAo+BDNF+NSCs组),每组16只,移植后进行神经功能损害评分(NSS),用免疫组织化学行BrdU、nestin、BrdU/NSE检测,分析结果.结果 移植后的2、4周神经功能评分分别为:A组5.3±0.5、5.3±0.5;B组4.0±0.8、3.8±0.5;C组3.5±0.6、3.5±0.6;D组2.0 ±0.8、1.8±1.0,D组显著好于其他3组(P<0.05),B组与c组显著好于A组(P<0.05).nes.tin阳性细胞数:A组1.24±1.13,B组2.59±1.44(P<0.05),BrdU阳性细胞数:A组0.52±0.68,B组1.65±1.10(P<0.05).BrdU阳性细胞数:C组6.08±1.52,D组10.26±1.96(P<0.05),BrdU/NSE双阳性细胞数:C组1.74±1.04,D组3.58±1.20(P<0.05).结论 BDNF和NSCs移植单独及联合应用对MCAo大鼠的神经功能恢复均有作用,两者联合具有协同作用.BDNF对内源性NSCs的激活、增殖有促进作用,对外源性NSCs的增殖、迁移及分化有促进作用.     

Isoflurane Preconditioning Improves Long-term Neurologic Outcome after Hypoxic-Ischemic Brain Injury in Neonatal Rats

Background: Preconditioning the brain with relatively safe drugs seems to be a viable option to reduce ischemic brain injury. The authors and others have shown that the volatile anesthetic isoflurane can precondition the brain against ischemia. Here, the authors determine whether isoflurane preconditioning improves long-term neurologic outcome after brain ischemia.

Methods: Six-day-old rats were exposed to 1.5% isoflurane for 30 min at 24 h before the brain hypoxia-ischemia that was induced by left common carotid arterial ligation and then exposure to 8% oxygen for 2 h. The neuropathology, motor coordination, and learning and memory functions were assayed 1 month after the brain ischemia. Western analysis was performed to quantify the expression of the heat shock protein 70, Bcl-2, and survivin 24 h after isoflurane exposure.

Results: The mortality was 45% after brain hypoxia-ischemia. Isoflurane preconditioning did not affect this mortality. However, isoflurane preconditioning attenuated ischemia-induced loss of neurons and brain tissues, such as cerebral cortex and hippocampus in the survivors. Isoflurane also improved the motor coordination of rats at 1 month after ischemia. The learning and memory functions as measured by performance of Y-maze and social recognition tasks in the survivors were not affected by the brain hypoxia-ischemia or isoflurane preconditioning. The expression of Bcl-2, a well-known antiapoptotic protein, in the hippocampus is increased after isoflurane exposure. This increase was reduced by the inhibitors of inducible nitric oxide synthase. Inducible nitric oxide synthase inhibition also abolished isoflurane preconditioning-induced neuroprotection.     

无骨折脱位型颈脊髓损伤的治疗

目的:探讨多节段无骨折脱位颈脊髓损伤的治疗。方法:多节段无骨折脱位型颈脊髓损伤21例,均行单开门颈椎管扩大减压成形术。采用JOA、Frankel分级及影像学进行疗效评价。结果:平均随访2年1个月,JOA评分术后改善率为37.81%,Frankel分级A→B 1例,B→C 7例,C→C 1例,C→D 10例,D→D 2例,D→E 4例。影像学检查提示颈椎生理曲度正常,未发现有再关门及不稳定现象。结论:单开门棘突重建颈椎管扩大成形术由于重建了颈后方韧带复合体,对于改善和维持颈椎的生理屈度、稳定性方面有重要的临床意义。     

GS23PPAEDIATRIC SURGERY PERFORMED BY GENERAL SURGEONS IN A PROVINCIAL NEW ZEALAND (NZ) HOSPITAL

Purpose To perform an audit of paediatric surgical patients in a provincial general surgical unit. Methodology Data was prospectively recorded using a standardized proforma on all children aged up to 15 yrs, seen between 11th December 2005 and 11th December 2006. Results There were 209 admissions (194 children), median age 8 yrs (6 wks–15 yrs) with 153 (73%) acutes. 37 children (18%) were under 2 yrs. Male : female ratio was 3 : 2. Procedures (n = 119) were appendicectomy (35), inguinal herniotomy (30), skin procedures (29), endoscopy (10), testicular (10) and others (5). The commonest acute and elective operations were appendicectomy and inguinal herniotomy respectively. 51% of operations were acute. There were 10 tertiary hospital transfers (5%) for burns (4), pyloric stenosis (3), intussusseption (1), neonatal inguinal hernia (1) and pyoderma gangrenosum (1). Median age of transfers was 11 months (6 wks–14 yrs). Complications were wound infection (1), post‐operative ileus (2) and infarcted ovary (1). Conclusion There are increasing moves towards centralization in paediatric surgery. 1 With only 4 paediatric tertiary centres in NZ, many general surgeons routinely perform paediatric surgery. A large number of children presented to our surgical department. Around half of these children required surgery and half of operations were acute. There is still a significant need for general paediatric surgery in the provinces and hence close collaboration with specialist paediatric surgeons.     

Klippel-Feil syndrome plus atretic meningocele in one identical twin and anencephaly in the other.

Klippel-Feil syndrome (KFS) is a heterogeneous entity, characterized by specific congenital anomalies of segmentation of the cervical spine. We report a case of KFS plus atretic meningocele in one identical twin and anencephaly in the other. These identical twins were both male with no chromosome defect. One of them had anencephaly diagnosed at the gestational age of 17 weeks and died soon after birth, whereas the co-twin had KFS with multiple congenital anomalies including short neck with low hairline, occipital atretic meningocele, butterfly vertebrae, hemivertebrae, cervico-thoracic scoliosis, left thumb preaxial polydactyly, and right undescended testis. He received rehabilitation during infancy and could walk at the age of 15 months. Both of these infants had preaxial polydactyly, which is an uncommon anomaly associated with KFS. In conclusion, iniencephaly and anencephaly are probably the extreme manifestations of KFS rather than different dysraphisms. Prompt clinical suspicion with early diagnostic imaging for spine lesions and occult opening of neural tube is mandatory for further intervention and rehabilitation.