肺脏超声评价儿童重症肺炎疗效的应用分析

目的:探讨肺脏超声（LUS）评价儿童重症肺炎（SP）疗效的应用价值。方法:选取142例儿童SP患者，回顾性根据临床疗效判断标准分为治愈组75例、好转组49例、无效组18例。分别于入院时、入院第7天和第15天对所有患儿行LUS及X线片检查，观察3组患儿肺部征象，并进行LUS评分。入院第15天时，采用临床肺部感染评分（CPIS）评估3组肺部感染情况，采用血气分析仪检测肺泡-动脉氧分压差（A-aDO2）及氧合指数（OI）水平，采用Pearson相关系数分析入院第15天LUS评分与CPIS、A-aDO2和OI的关系。结果:入院第7天和第15天治愈组患儿LUS评分、坐位B线数和平卧位B线数均少于好转组和无效组（P<0.05）。治愈组患儿胸膜线异常和A线消失率低于好转组和无效组（P<0.05）。治愈组患儿入院时和入院第7天胸腔积液LUS检出率高于X线片（P<0.05），无效组患儿入院时和入院第15天LUS胸腔积液检出率高于X线片（P＜0.05）。治愈组患儿CPIS和A-aDO2水平低于好转组和无效组（P<0.05），OI水平高于好转组和无效组（P<0.05）。Pearson相关性分析结果显示，入院第15天LUS评分与CPIS和A-aDO2呈正相关（P<0.05），与OI呈负相关（P<0.05）。结论:LUS及LUS评分能够有效评估儿童SP的临床疗效，且胸腔积液检出率更高，具有较高的临床应用价值。 【关键词】肺脏超声；儿童；重症肺炎；肺脏超声评分；临床疗效     

以合理用药为核心的中药临床药师参与新型冠状病毒肺炎（NCP）防治的基本切入点及必要性分析＊

新型冠状病毒肺炎爆发以来，我国以最快的响应速度发布了《新型冠状病毒感染的肺炎诊疗方案》，并明确指示在新型冠状病毒肺炎防治工作中建立健全中西医协作机制，使中医药尽早、尽快参与其中，积极发挥其作用。本研究从中药临床药学的角度，以国家及各省区发布的新型冠状病毒肺炎的预防及诊疗方案为切入点，分析中药临床药师参与新型冠状病毒肺炎防治的可行性及必要性，提出中药临床药师参与新型冠状病毒肺炎的防治及公共卫生突发事件的观点，以期能为壮大中医药参与传染性疾病队伍，完善中医药多力量参与公共卫生突发事的体制提供参考。     

妇科急腹症中的超声临床诊断研究

目的:探讨妇科急腹症中的超声临床诊断研究。方法:纳入40例患者作为研究样本,40例患者均为2017年3月-2019年7月入院接受治疗的妇科急腹症患者,采用随机分组的方式,将40例患者分为两组,每组各20例患者,两组患者接受不同的诊断方式,对照组接受常规诊断,研究组接受超声诊断,对比两组患者诊断准确率。结果:观察并对比两组患者的数据,常规诊断以及超声诊断的临床准确率对比,研究组的准确率高于对照组,两组患者的组间数据对比,表明本次研究具有统计学意义(P<0.05)。结论:妇科急腹症中采用超声诊断,对急腹症类型的诊断效果较为准确,为患者后续的临床治疗提供诊断依据,证实了超声诊断对妇科急腹症在临床诊断上具有重要作用,应提倡将其纳入常规诊断之中。     

A review of the safety and clinical utility of contrast echocardiography

There are limitations to the sensitivity and specificity of conventional two-dimensional echocardiograms in making an accurate diagnosis in certain patient populations. This led to the development of specific contrast-enhancing agents with the following characteristics: small enough to cross the pulmonary capillary bed, remain stable throughout the length of the procedure, do not dissolve in blood, and rapidly cleared from the body with low toxicity. Unfortunately, the use of contrast echocardiography has not taken off as expected. The low take-up rate among clinicians can largely be attributed to the black box warning by the United States Food and Drug Administration in 2007, after the coincidental occurrence of four patient deaths and about 190 severe cardiopulmonary reactions shortly after contrast agent administration. In this article, we address the clinical safety of contrast agents, share our institution’s experience in using it and elaborate on the clinical indications of contrast echocardiography.     

Uncertainty and certain death: the role of clinical trials in terminal cancer care

We consider uncertainty in relation to clinical trials for terminal non-small cell lung cancer, which is an aggressive and difficult to treat form of cancer. Using grounded theory to analyse 85 clinical interactions between doctors, patients and family members, we argue that uncertainty is a major source of tension for terminally ill patients, with individuals confronting a choice between transitioning to palliative care or volunteering for an experimental/trial medication that might postpone death. Regardless of their efficacy, patients must also consider how such experimental treatments might impact their quality-of-life. We argue that clinical trials produce uncertainty through (i) discussions about the efficacy of clinical trials; (ii) the physiological consequences of clinical trial medications; and (iii) the impact clinical trials have on patient's prognostic understanding of their terminal cancer. Accordingly, while study participants encounter high prognostic certainty (i.e. they have a fatal cancer), they nonetheless experience considerable uncertainty in relation to their participation in clinical trials.     

A comparative study on clinical characterizations between acute myelitis onset of neuromyelitis optica spectrum disease and idiopathic transverse myelitis

ABSTRACT

Background/Aims

Both of neuromyelitis optica spectrum disease (NMOSDs) and idiopathic transverse myelitis (ITM) could present as acute transverse myelitis. However, long-term immunological treatment and prognosis are different for high recurrence of NMOSDs. In this study, we summarized clinical differences between acute attack myelitis of NMOSDs and ITM, we further screened serum auto-antibodies to help understand the two distinct clinical entities.     

四肢烧伤患者行急诊负压封闭引流术的疗效观察

目的探究应用急诊切痂植皮配合负压封闭引流术治疗四肢烧伤的临床疗效。方法按随机抽取法将医院2018年2月—2019年1月间收治的57例四肢烧伤患者分为常规组和实验组,常规组28例,实验组29例。给予常规组患者急诊切痂植皮,用常规换药配合治疗,而实验组在常规组的基础上用负压封闭引流术配合治疗。比较常规组患者和实验组患者的临床效果、疼痛程度评分。结果两组患者的总有效率对比,实验组总有效率吗,明显高于常规组的总有效率,实验和常规组差异具有统计学意义(P<0.05)。常规组患者的疼痛评分高于实验组患者,差异具有统计学意义(P<0.05)。结论四肢烧伤患者通过应用急诊切痂植皮配合负压封闭引流术治疗后,临床效果得到有效改善,质量生活水平得到提高。     

Evolution of parental knowledge and efficacy across the pediatric neuropsychological evaluation process

Objective: The handful of studies examining parent satisfaction after pediatric neuropsychological evaluations have focused on post-evaluation appraisals. By examining parent experiences across the course of their child’s evaluation, this study aimed to provide important insights into how and when parents experience changes in knowledge, understanding of care options, and efficacy during evaluation process.

Method: Parents of youth receiving neuropsychological evaluation completed questionnaires at four time points (prior to evaluation [n?=?363], day of testing [n?=?300], prior to feedback [n?=?250], and post-report [n?=?99]). Parents rated aspects of their knowledge and efficacy regarding their child’s functioning. Parents also rated their perception of the neuropsychologist, medical provider, and school along the same domains. The resulting longitudinal data were analyzed using structural equation modeling and ANCOVA. Although primary analyses focused on the entire sample, differences between first-time evaluations and re-evaluations were also examined.

Results: Families receiving an initial evaluation showed lower ratings in knowledge, awareness of options, and efficacy at the beginning of the evaluation and a significant increase in ratings by the end of the evaluation. Families returning for re-evaluation showed higher initial ratings that changed comparatively little during the evaluation. Parents receiving initial evaluations also perceived increased knowledge of their child by medical providers and school.

Conclusion: The study supports the clinical assumption that parents gain knowledge about their child and treatment options during a neuropsychological evaluation. The difference between initial and re-evaluation warrants further study. Studying the process and experience of neuropsychological evaluation may provide more nuanced findings than post hoc satisfaction measures.