大剂量肾上腺素治疗急性心脏骤停的效果分析

目的分析大剂量肾上腺素在急性心脏骤停院前急救中的应用价值。方法将2018年1月-2019年10月院前急救处理的52例急性心脏骤停患者视为研究对象,根据其治疗方式划入常规组与大剂量组(n=26)。常规组使用常规剂量肾上腺素与阿托品治疗,大剂量组使用高剂量肾上腺素与阿托品联合治疗,比较患者的治疗效果。结果常规组患者的院前急救复苏成功率是57.69%,大剂量组患者的院前急救复苏成功率是84.62%,且常规组患者的自主循环恢复率、自主呼吸恢复率均低于大剂量组患者,差距比较有统计学意义(P<0.05)。常规组患者治疗后发生8例并发症,大剂量组患者治疗后出现2例并发症(P<0.05)。结论大剂量肾上腺素在急性心脏骤停院前急救中的使用,可提升患者的复苏成功率,恢复患者的自主呼吸、循环能力,降低患者并发症发生率。     

学龄前儿童第一次看牙牙科畏惧症调查研究

目的通过对学龄前儿童第一次看牙行为的调查，找出与看牙经验无关的既存因素与牙科畏惧症（dental fear，DF）发病情况的关系。方法采用Venham临床焦虑及合作行为级别评定表对160例未看过牙医的患儿进行调查及统计分析。结果各年龄组间及不同性别患者间DF发生率差异无显著性。不同居住地儿童DF发生率比较差异有显著性（Х^2=3．976，P〈0．05），母亲文化程度不同的患儿DF发生率比较，大学及以上组与初中及以下组间差异有显著性（Х^2=6．518P〈0．05），口腔卫生状况不同的患儿DF发生率比较，口腔卫生状况良好组低于一般和较差组，差异有显著性（Х^2=7．476，P〈0．05）.结论口腔卫生，居住地及照顾人文化程度与DF发病有关。良好的口腔卫生习惯对于学龄前儿童初次看牙行为具有极其正面的影响力，因此做好儿童口腔保健及宣传教育，对缓解学龄前儿童牙科畏惧症的发生有积极的作用。     

Association Between Serum Albumin Level and All-Cause Mortality in Patients With Chronic Kidney Disease: A Retrospective Cohort Study

BackgroundThe association between serum albumin and all-cause mortality (ACM) in patients with chronic kidney disease (CKD) is presently unclear.MethodsThe study subjects included 201 patients diagnosed with CKD, eliminating those with end-stage renal disease, who were admitted to our hospital from January 2014 to January 2015. The patients were divided into 4 groups according to serum albumin level (Q1: 1.60–3.88 g/dL; Q2: 3.89–4.13 g/dL; Q3: 4.14–4.43 g/dL, and Q4: 4.44–5.51 g/dL). The clinical outcome was ACM, and the difference was compared using odds ratio (OR) and 95% confidence interval (CI).ResultsAfter a median follow-up of 1480 days, 32 patients died (15.92%). The ACM was found to be 28.00%, 20.00%, 8.00%, and 7.84% in the 4 groups (P = 0.012). Pearson correlation analysis revealed a positive association between the serum albumin level and glomerular filtration rate (GFR) (r = 0.22, P = 0.001). Once the potential confounding factors were adjusted, the results indicated that decreased serum albumin was a risk factor for ACM (Q2 vs Q1: OR = 0.50, 95% CI: 0.17–1.47; Q3 vs Q1: OR = 0.12, 95% CI: 0.03–0.48; Q4 vs Q1: OR = 0.26, 95% CI: 0.07–0.98). The receiver operating characteristic curve indicated that the optimum threshold of serum albumin to predict ACM was 4 g/dL, and the area under the curve was 0.69 (95% CI: 0.60–0.79).ConclusionsDecreased serum albumin is a risk factor for ACM in patients with CKD, with the optimal threshold being 4 g/dL.     

Nicotine effects on exercise performance and physiological responses in nicotine‐naïve individuals: a systematic review

The purpose of this systematic review was to evaluate the effects of smokeless forms of nicotine on physiological responses and exercise performance. Methodology and reporting were based on the PRISMA statement. The intervention was defined as any product containing nicotine that did not require smoking. Searches were conducted across two electronic databases with supplementary approaches utilized. Studies were selected following set inclusion and exclusion criteria and checked by two independent authors. A modified PEDro scale was utilized to rate study quality with studies averaging 9·3/13. Six studies assessed exercise performance with endurance‐based parameters reported as significantly improved with nicotine in one study, while anaerobic parameters were unaffected or decreased compared to placebo except in one study which reported enhanced leg extensor torque but no effect on countermovement jump or Wingate anaerobic capacity. Sixteen of 28 studies investigating physiological responses reported that nicotine significantly increased heart rate compared to placebo or control. Blood pressure and blood flow were also reported as significantly increased in multiple studies. While there is strong evidence of nicotine‐induced changes in physiological function that would benefit physical performance, beneficial effects have only been reported on leg extensor torque and endurance performance by one study each. Subsequently, there is need for more research with strong methodological quality to definitively evaluate nicotine's potential as an ergogenic aid.     

The effects of merit-based financial aid on drinking in college

We study the effect of state-level merit aid programs (such as Georgia's HOPE scholarship) on alcohol consumption among college students. Such programs have the potential to affect drinking through a combination of channels – such as raising students’ disposable income and increasing the incentive to maintain a high GPA – that could theoretically raise or lower alcohol use. We find that the presence of a merit-aid program in one's state generally leads to an overall increase in (heavy) drinking. This effect is concentrated among men, students with lower parental education, older students, and students with high college GPA's. Our findings are robust to several alternative empirical specifications including event-study analyses by year of program adoption. Furthermore, no difference in high-school drinking is observed for students attending college in states with merit-aid programs.     

The HAS-Choice study: Utilizing the HEART score,an ADP,and shared decision-making to decrease admissions in chest pain patients

Objective

The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol (ADP), and shared decision-making using a visual aid in the evaluation of chest pain patients. We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) setting while maintaining safe patient care.