Decision-making for extremely preterm infants with severe hemorrhages on head ultrasound: Science,values, and communication skills

Severe intracranial hemorrhages are not rare in extremely preterm infants. They occur early, generally when babies require life-sustaining interventions. This may lead to ethical discussions and decision-making about levels of care. Prognosis is variable and depends on the extent, location, and laterality of the lesions, and, importantly also on the subsequent occurrence of other clinical complications or progressive ventricular dilatation. Decision-making should depend on prognosis and parental values. This article will review prognosis and the uncertainty of outcomes for different lesions and provide an outline of ways to conduct an ethically appropriate discussion on the decision of whether to continue life sustaining therapy. It is possible to communicate in a compassionate and honest way with parents and engage in decision-making, focussing on personalized information and decisions, and on function, as opposed to diagnosis.     

Association of Epicardial and Tissue-Level Reperfusion with Left Ventricular End-Diastolic Pressures in ST-Elevation Myocardial Infarction

Unfavorable hemodynamics among patients with ST-elevation myocardial infarction (STEMI) have been associated with adverse clinical outcomes and may be linked to a failure to achieve complete reperfusion. We hypothesized that impaired epicardial and tissue-level perfusion after fibrinolytic therapy would be associated with adverse hemodynamics. The relationship between left ventricular end-diastolic pressure (LVEDP), baseline clinical characteristics, and angiographic findings were examined in 666 patients with STEMI treated with fibrinolytic therapy from the TIMI 14, INTEGRITI (TIMI 20), ENTIRE (TIMI 23), and FASTER (TIMI 24) trials. LVEDP was analyzed as a dichotomous variable with an elevated LVEDP defined as LVEDP >18 mmHg (median value). Higher post-fibrinolytic LVEDP was associated with age > or = 65, female gender, Killip Class II-IV on presentation, and LAD culprit location. Elevated LVEDP was associated with both a closed infarct-related artery (58.8% of TIMI Flow Grade (TFG) 0/1 with elevated LVEDP vs. 46.6% of TFG 2/3, p = 0.03) and impaired myocardial perfusion (55.7% of TIMI Myocardial Perfusion Grade (TMPG) 0/1 with elevated LVEDP vs. 43.8% of TMPG 2/3, p = 0.02). In a multivariate analysis, impaired myocardial perfusion (OR 1.7, p = 0.02), abnormal Killip Class (OR 4.8, p = 0.001), age > or = 65 (OR 1.6, p = 0.04), and female gender (OR 1.9, p = 0.01) were independently associated with elevated LVEDP. Elevated LVEDP was independently associated with a greater incidence of in-hospital (OR 11.8, p = 0.02) and 30-day congestive heart failure (OR 4.4, p = 0.02). In STEMI, angiographic indices of incomplete reperfusion are associated with an elevated LVEDP, and elevated LVEDP is associated with adverse clinical outcomes.     

足部穴位按摩护理0级糖尿病足患者有效性的系统评价

目的:对足部穴位按摩护理0级糖尿病足的相关文献进行系统评价,证实其应用效果,为临床实践提供参考.方法:计算机检索Cochrane Library、PubMed、Embase、Web of Science、Ebsco、中国知网(CNKI)、万方数据知识服务平台(WanFang Data)、维普期刊资源整合服务平台(VIP...     

私立学校初三学生考试成败归因特点研究

目的 研究私立学校初三学生考试成败的归因特点，为实际教育工作提供依据。方法 采用中小学生考试成败归因量表和自尊量表对236名学生进行了调查。结果 ①“失败”是影响学生进行考试结果归因的主要因素。②学生在归因时存在“自利性归因偏差”，并且有“习得性无助感”。结论 需对学生进行积极的归因训练。     

Primary intracranial haemangiopericytoma: Comparison of survival outcomes and metastatic potential in WHO grade II and III variants

Primary intracranial haemangiopericytomas (HPC) are rare, highly vascular tumours with a high propensity for local recurrence and distant metastasis. Optimal treatment includes maximal surgical resection followed by adjuvant radiotherapy. In 2007, new histopathological grading criteria were introduced to differentiate between high grade (World Health Organization [WHO] grade III) and low grade (WHO grade II) tumours. Given the rarity of this tumour, there is a paucity of information regarding the prognostic significance of histological grade. We conducted a retrospective review of our 20 year experience in treating 27 patients with HPC at our institution. Statistical analysis to compare overall survival, local recurrence rate and metastatic potential between the two grades were conducted using Kaplan–Meier analysis. The estimated median survival for grade II HPC was 216 months and for grade III tumours was 142 months. On multivariate analysis, grade II tumours were associated with better survival than grade III lesions (hazard ratio = 0.16, 95% confidence interval 0.26–0.95; p = 0.044). During the study period, 33% of grade III tumours developed local recurrence compared to 21% of grade II tumours. Metastases were found in 36% of grade II patients and 25% of grade III patients. There was no significant statistical difference in local recurrence rate and metastasis between the two grades. Higher histological grading in HPC is associated with worse overall survival. However based on our series higher histological grading is not associated with higher local recurrence or distant metastatic rates.     

大学生人格的年级变异性

目的探讨大学生人格变化与所处年级的关系。方法采用卡特尔人格问卷(16PF)对浙江农林大学健康管理专业大一至大三104名学生进行为期一学年前后测评。结果①具有统计学显著性变异的人格因子一年级有:C(t=2.079,P<0.05)、E(t=-3.606,P<0.01)、G(t=-2.456,P<0.05)、L(t=-4.86,P<0.01)、Q3(t=2.447,P<0.05)、Q4(t=-2.893,P<0.01);二年级有:E(t=-3.438,P<0.01)、I(t=3.369,P<0.01)、X3(t=-3.747,P<0.01)、Y2(t=-2.5277,P<0.05);三年级有:E((t=-2.832,P<0.01)、M(t=-3.092,P<0.01)、Q1(t=-2.361,P<0.05)、X4(t=-4.629,P<0.01)、Y2(t=-2.603,P<0.05);②不同年级相比,变异程度大的人格因子主要有C(t=-2.103,P<0.05)、I(t=2.321,P<0.05)、X1(t=2.25,P<0.05)、X3(t=-2.052,P<0.05);Q4(t=2.081,P<0.05)、X4(t=-2.322～-2.143,P<0.05)。结论大学生人格变异具有年级特点,一年级人格因子值提高的有C、Q3;降低的有E、G、L、Q4;二年级提高的有I,降低的有E、X3、Y2;三年级人格因子值降低的有E、M、Q1、X4、Y2。并且,情绪性因子变异程度较大。     

地区级三级医院学科建设的探讨

结合本医院创建重点专科的经验、总结了地区级三级医院创建临床重点专科的基本原则,重点学科建设的目标与战略定位,加强学科建设的具体措施,为促进医院重点专科建设取得实效,促进医院可持续发展提供借鉴。