Long term outcome of elective day case percutaneous coronary intervention in patients with stable angina

Patients undergoing elective PCI are traditionally admitted overnight, however day case PCI cuts costs and has been proposed as a safe method for selected patients. We evaluated the success and long term clinical outcomes of day case percutaneous coronary intervention (PCI) for outpatients with stable angina.In total, 484 consecutive patients treated over a five year period with planned day case PCI were studied and followed up for 12 months. Successful PCI with same day discharge was performed in 463 patients (95.7%). There were 21 patients (4.3%) who required hospital admission. Reasons for failed discharge were hematoma formation (n = 7, 1.4%), coronary dissection (n = 4, 0.8%), post-procedural chest pain (n = 3, 0.6%), prolonged procedure (n = 2, 0.4%), and 1 each of acute stent thrombosis, coronary perforation, anaphylaxis, minor drug reaction and a functional study for untreated disease. One year follow up was complete for 439/484 (90.7%). At 12 months there were 6 hospitalizations for angina (1.2%, 95% CI 0.6–3.0%), 20 repeat revascularisations (4.1%, 95% CI 2.7–6.3%), 3 myocardial infarctions (0.6%, 95% CI 0.2–2.1%) and 2 deaths (0.4%, 95% CI 0.1–1.6%). Event free survival at 1 year follow up was 93.6% (95% CI 90.7–95.6%).Selecting patients for day case PCI is safe, and can achieve a high rate of success with excellent long term outcomes.     

Paternal effects on offspring fitness in a multimale primate society

When females mate with multiple males, paternal care is generally expected to be negligible, because it may be difficult or impossible for males to discriminate their own offspring from those of other males, and because engaging in paternal care may reduce male mating opportunities. Consequently, males in multimale societies are not predicted to provide direct benefits to their offspring. We have recently demonstrated, however, that males in a typical multimale primate society (yellow baboons, Papio cynocephalus) discriminate their own offspring from those of other males and provide care to them in the form of repeated support during agonistic encounters. This observation raises the question of whether fathers enhance offspring fitness in this species. Here we use 30 years of data on age at maturity for 118 yellow baboons with known fathers. We show that the father's presence in the offspring's social group during the offspring's immature period accelerated the timing of physiological maturation in daughters. Sons also experienced accelerated maturation if their father was present during their immature period, but only if the father was high ranking at the time of their birth. Because age at reproductive maturity has a large impact on lifetime reproductive success, our results indicate a direct effect of paternal presence on offspring fitness. This relationship in turn suggests that the multiple roles that males play in multimale animal societies have not been sufficiently examined or appreciated and that paternal effects may be more pervasive than previously appreciated.     

Usefulness of a state-legislated,comparative database to evaluate quality in colorectal surgery

PURPOSE: Colorectal surgery, a high-volume procedure, has been targeted for performance improvement to reduce length of stay. Specific postoperative quality indicators and readmission rates should be analyzed concomitantly to assure that adverse events are not associated with earlier discharge. METHODS: From July 1, 1990, to June 30, 1997, 1,218 consecutive patients who underwent transabdominal colorectal surgery were analyzed for length of stay, mortality, morbidity, and discharge disposition. Each patient was assigned an Admission Severity Group rating 0 to 4 using a hospital-based state-legislated software system (Atlas) to validate comparative performance internally and externally. Readmission data within 120 days of discharge were available for the last 678 consecutive patients from July 1, 1993, to June 30, 1997, using Lastword (computerized medical records). RESULTS: The annual frequencies of the 1,218 procedures were 173, 183, 175, 146, 167, 189, and 185, respectively, from July 1990 through June 1997. Severity distribution was 32 for Admission Severity Group 0, 517 for Admission Severity Group 1, 540 for Admission Severity Group 2, 128 for Admission Severity Group 3, and 1 for Admission Severity Group 4, with no annual difference (P=0.012). There was a significant reduction in total length of stay of 3.1 (12.9–9.8) days during the seven years (P=0.001). The overall operative mortality rate was 1.4 percent, and the morbidity was 2.6 percent, with no annual differences (P=0.655 andP=0.033, respectively). The disposition to home did not change (P=0.21). Of the 678 patients followed up for readmission, 100 (14.7 percent) were readmitted within 120 days, with no annual difference (P=0.302). CONCLUSION: Mortality, morbidity, disposition, and readmission rates were not affected by a decreased length of stay after colorectal surgery.Presented at the Research Forum at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.     

预防性护理在血液透析患者感染控制中的应用效果

目的：探讨预防性护理在血液透析患者感染控制中效果。方法整群选取2012年1月—2014年5月该院收治的血液透析患者共75例,并随机分为对照组(n=37)和观察组(n=38)。对照组给予常规性护理,观察组给予预防性护理,比较两组的感染发生情况、住院总时间和护理满意程度。结果经不同的护理干预后,观察组未发生感染事件,对照组感染率为27.6%,观察组显著地低于对照组(c2=5.851,P=0.016);观察组住院时间为(18.2±3.7)d,显著地低于对照组的(23.8±4.5)d(t=0.8945,P=0.000);观察组护理满意度率为97.4%,显著地高于对照组的78.4%(c2=5.851,P=0.016)。结论预防性护理能够有效地预防血液透析感染,缩短住院时间,有效地提高护理满意程度,应在血液透析中加强预防性护理干预。     

突发性聋合并耳鸣患者实施护理对降低心理负面情绪的影响

目的：观察不同护理干预方法对突发性耳聋合并耳鸣患者负面情绪的影响。方法：研究对象为本院耳鼻喉科80例突发性耳聋合并耳鸣患者,其中接受常规护理的40例患者为对照组,在常规护理基础上接受综合护理的40例患者为观察组,比较两组患者护理前后的匹兹堡睡眠质量指数、汉密顿焦虑量表评分和抑郁自评量表评分。结果：护理前,两组患者的各项观察指标比较,差异无统计学意义（P>0.05）;护理后,观察组各项观察指标均优于对照组,比较差异有统计学意义（P<0.05）。结论：给予突发性耳聋合并耳鸣患者一定的护理干预可改善患者的睡眠质量和心理状态,且综合性护理的改善效果优于常规护理。     

用精益管理方法提高麻醉复苏室运转效率的研究

目的:应用精益管理方法提升麻醉复苏室的运转效率。方法:按照精益管理的方法评估、分析、改进复苏室工作,对改进前2012年和改进后2013年的工作量,护士加班超时及复苏室满意度等情况进行效果评价。结果:改进后复苏例数增长了98.4%,复苏室护士超时数下降了63.1%,病人在复苏室的逗留时间下降了14.8%,手术室麻醉科人员对复苏室工作的满意度均有明显的提高。结论:应用精益管理方法能有效地提高复苏室的运转效率。     

延续护理对消化性溃疡患者自我监控情况及心理状况的影响

目的 探讨延续护理对消化性溃疡患者自我监控能力和心理状况的影响.方法 选择消化性溃疡患者94例,采用随机数字表法将患者分为试验组48例和对照组46例,试验组采用延续护理随访模式,对照组实施常规出院指导,比较两组患者入院时及出院后6个月患者自我监控疾病情况及心理状况,出院后6个月分别记录患者溃疡愈合情况及幽门螺杆菌感染阳性发生率.结果 出院后6个月试验组患者自我监控各项指标较对照组明显提高x2=10.788,复发率较对照组减少;患者抑郁、焦虑情绪较对照组明显改善,t=-4.313、-6.929;试验组患者消化性溃疡愈合及幽门螺杆菌感染阳性率较对照组Z=-2.066、-2.108.结论 延续护理有利于提高消化性溃疡出院患者自我监控能力,同时改善患者的心理状况.     

概述美国的药学服务实践流程变迁

摘 要 目的： 概述美国的药学服务实践流程变迁,为我国开展药学服务工作提供借鉴。方法: 查阅文献,对美国医院药学相关学会组织提出的药学服务实践流程进行总结、分析。结果与结论:美国药学从业者联合委员会提出的以患者为中心的药学服务完整总结了其实践流程,包括采集-评估-计划-实施-随访等步骤,强调与团队的沟通、合作、资源共享,适合任何工作环境对患者提供的药学服务。