Train hard and well but train intelligently: a comment on 'Operative experience of urological trainees in the UK'

Study Type – Prognosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Married individuals have lower morbidity and mortality rates for all major causes of death. Cancer‐specific survival is better in married patients with testis cancer, prostate cancer, breast cancer, cervical cancer, as well as head and neck cancers. We have found the effect of marital status on outcomes after radical cystectomy to be variable, depending on gender and the outcome addressed. Being married is predictive of lower all‐cause mortality for both men and women relative to their separated, divorced or widowed (SDW) or never‐married counterparts. It is also predictive of lower bladder‐cancer‐specific mortality relative to SDW individuals. Marriage also exerts a protective effect on men regarding non‐organ‐confined disease, with those never having married having significantly higher rates.

OBJECTIVES

• ? To examine the effect of marital status (MS) on the rate of non‐organ‐confined disease (NOCD) at radical cystectomy (RC)
• ? To assess the effect of MS on the rate of bladder‐cancer‐specific mortality (BCSM) and all‐cause mortality (ACM) after RC for urothelial carcinoma of the urinary bladder (UCUB).

MATERIALS AND METHODS

• ? A total of 14 859 patients, who underwent RC for UCUB, were captured within the Surveillance, Epidemiology, and End Results database, between 1988 and 2006.
• ? Logistic regression analysis was used to assess the rate of NOCD (T_3‐4/N_I‐3/M₀) at RC and Cox regression analyses were used to assess BCSM and ACM.
• ? Analyses were stratified according to gender; covariates included socio‐economic status, tumour stage, age, race, tumour grade and year of surgery.

RESULTS

• ? Never‐married males had a higher rate of NOCD at RC (odds ratio = 1.22, P= 0.004), an effect not found in never‐married females.
• ? Separated, divorced or widowed (SDW) males (hazard ratio [HR]= 1.18, P= 0.005) and females (HR = 1.16, P= 0.002) had higher rates of BCSM than their married counterparts.
• ? SDW and never‐married males had higher rates of ACM than their married counterparts (HR = 1.22, P < 0.001 and HR = 1.26, P < 0.001, respectively).
• ? SDW and never‐married females also had higher rates of ACM than married females (HR = 1.24, P < 0.001 and HR = 1.22, P= 0.01, respectively).

CONCLUSIONS

• ? For both men and women, being SDW conveyed an increased risk of BCSM after RC.
• ? SDW and never marrying had a deleterious effect on ACM.
• ? Unfavourable stage at RC was also seen more commonly in never‐married males.

     

胃癌患者术后早期肠内营养对临床结局的影响

目的观察术后早期肠内营养对胃癌患者临床结局的影响。方法将2010年7月至2011年5月间青岛大学医学院附属医院收治的60例胃癌患者按随机数字表法分为试验组和对照组．每组30例。试验组患者术后早期少量多次进水加肠内营养制剂,对照组患者术后采用传统围手术期治疗方案。比较两组患者临床结局、术后免疫功能及营养状况。结果试验组与对照组患者术后发热时间[（81．1±6．4）h比（87．3±8．0）h,P〈0．05]、排气时间[（79．9±9．5）h比（86．6±8．7）h,P〈0．05]和住院时间[（7．83±2．23）d比（9．57±1．96）d,P〈0．01]比较,差异均有统计学意义;治疗费用分别为（30．22±3．22）千元和（34．60±32．12）千元,差异亦有统计学意义（P〈0．01）;两组术后并发症发生率的差异无统计学意义[13．3％（4／30）比16．7％（5／30）,P〉0．05]。术后第3和第7天,试验组患者CD3＋、CD4＋、NK细胞、CD4／CD8、白蛋白和前白蛋白水平均明显高于对照组（均P〈0．05）,而CD8＋细胞显著下降．与对照组比较．差异亦有统计学意义（P〈0．05）。结论术后早期经口进食肠内营养制剂能够改善胃癌患者术后营养状况以及免疫功能,促进肠道功能早期恢复。     

The impact of social networks and partnership status on treatment choice in men with localized prostate cancer

Study Type – Decision analysis (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Very little is known about prostate cancer decision‐making. Hence, marital status is often assumed a proxy for the amount of social support. While marital status is often used as a proxy for social support, we found that the quality of support may impact treatment type more than the extent of the social matrix.

OBJECTIVES

• ? To determine whether martial status and social support impact treatment choice.
• ? The decision to pursue radical prostatectomy for prostate cancer is often influenced by factors outside the realm of tumour risk, such as a man's support system at home.

PATIENTS AND METHODS

• ? We performed a retrospective cohort study of 418 low‐income men who were diagnosed with non‐metastatic prostate cancer and underwent definitive treatment with either radical prostatectomy or radiotherapy.
• ? We performed univariate and multivariate mixed‐effects logistic regression analysis, with the dependent variable being treatment type.
• ? Confidence intervals (CIs) for the predicted probabilities and relative risks were derived using bias‐corrected bootstrapping with 1000 repetitions.

RESULTS

• ? Men with two or more members in their support system were more likely to be older, Hispanic, have less than a high school education, earn more than US $1500 monthly, have high‐risk disease and be in a significant relationship.
• ? In multivariate analysis, partnered men with fewer than two social support members (relative risk, RR, 1.23; 95% CI, 1.02–1.63) were more likely to undergo surgery, whereas men who were morbidly obese (RR, 0.46; 95% CI, 0.09–0.88), high school graduates (RR, 0.80; 95% CI, 0.64–0.99) or had high‐risk disease (RR, 0.58; 95% CI, 0.44–0.85) were less likely to undergo surgery than their respective referent groups.
• ? Partnered men with two or more social support members were no more likely to undergo surgery than unpartnered men who lacked any social support.

CONCLUSIONS

• ? In the present study cohort, married men with fewer than two members in their social network were more likely to have undergone surgery.
• ? Although marital status is often used as a proxy for social support, we find that the quality of support and partner may impact treatment type more than the extent of the social matrix.

     

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营养不良一般指机体内任何一种营养素的失衡,包括营养不足、肥胖和超重。当人体处于健康状态时,可以通过合理膳食而使各种营养素在机体内维持平衡。但是对于住院病人,特别是危重病人而言,常常因各种营养素的摄入不足或流失过多等原因导致营养不足和机体各系统     

Racial Disparities in Depression and Life Satisfaction After Spinal Cord Injury: A Mediational Model

Purpose:

To identify the relationship of race and gender with 3 aspects of life satisfaction and depressive symptoms after spinal cord injury (SCI), evaluating the extent to which socioeconomic factors mediate any observed relationships.

Methods:

Adults with traumatic SCI of at least 1-year duration (N = 1,549) were identified through a Southeastern United States SCI Model System of care, and cross-sectional survey data were collected at a Southeastern United States medical university. Three aspects of life satisfaction (home life satisfaction, vocational satisfaction, global satisfaction) were measured using 20 satisfaction items from the Life Situation Questionnaire-Revised. The Older Adult Health and Mood Questionnaire measured depressive symptoms. MANCOVA assessed mediation of socioeconomic status between race and life satisfaction and depression.

Results:

Home life satisfaction and vocational satisfaction were significantly related to race, with White participants scoring higher than Black participants during the first stage of the regression. However, socioeconomic factors mediated the relationships such that race was no longer significant after considering economic factors. Race was significantly associated with global satisfaction after adjusting for socioeconomic factors. Depression was not significantly related to race. Gender was unrelated to all study outcomes. Of the socioeconomic mediators, family income was a significant predictor of each outcome, whereas education was only predictive of vocational satisfaction.

Conclusion:

Socioeconomic factors are important mediators of the relationship between race and certain aspects of life satisfaction among persons with SCI. Family income and, to a lesser extent, education should be considered when evaluating race differences in life satisfaction after SCI.     

加速康复外科指导下腹腔镜结直肠癌根治术后营养指标的变化分析

目的:观察加速康复外科(fast track surgery,FTS)联合腹腔镜技术对结直肠癌根治术后患者营养指标的影响。方法:将92例结直肠癌患者随机分为3组,Ⅰ组(n=31)应用传统围手术期处理行开腹手术,Ⅱ组(n=31)在FTS理念指导下行开腹手术,Ⅲ组(n=30)在FTS理念指导下行腹腔镜手术。3组患者分别于术前、术后第3天、术后第7天抽取外周血测定C反应蛋白(CRP)、白蛋白(ALB)、前白蛋白(PRE)、转铁蛋白(TRF)、视黄醇结合蛋白(RbP)、血红蛋白(Hb)等。结果:3组患者术后第3天、第7天CRP较术前均明显升高(P<0.01),与Ⅱ组、Ⅲ组相比,Ⅰ组患者术后第3天、第7天CRP升高更明显(P<0.01),与Ⅲ组相比,Ⅱ组升高明显(P<0.05)。术后第3天3组患者ALB、PRE、TRF、RbP、Hb水平均较术前明显减低,与Ⅱ组、Ⅲ组相比,Ⅰ组减低更明显;与Ⅲ组相比,Ⅱ组PRE、TRF、Hb降低更明显(P<0.05)。术后第7天,Ⅰ组各项指标仍低于术前(P<0.05),较第3天升高(P<0.05);Ⅱ组各项指标较术后第3天有所升高(P<0.05),且较Ⅰ组升高明显(P<0.05);Ⅲ组患者PRE、TRF、Hb恢复至术前水平,其他指标较术后第3天升高明显(P<0.05)。结论:应用FTS理念行腹腔镜结直肠手术,可更有效缓解术后炎症反应,维持患者术后营养状态,对术后患者康复具有积极作用。     

新医改以来我国全民健康信息化发展现况

阐述新医改以来我国全民健康信息化发展成效及存在的问题,从政策规划、重点领域系统建设、数据共享、健康医疗大数据应用、标准规范、信息安全及隐私保护等方面提出相关发展策略,以期对全民健康信息化发展有所启发。     

心理护理对乙肝合并肝纤维化患者不良心理状态和生存质量的影响

目的探讨心理护理对乙肝合并肝纤维化患者不良心理状态和生存质量的影响。方法本研究共纳入103例乙肝合并肝纤维化的患者作为研究对象,根据起始端心理状态评分,分为不良状态组(≥50分,38例)和正常状态组(50分,65例)。所有患者均进行一般的常规护理和心理护理,3个月后均再次进行心理状态、生存质量及治疗依从性评估。观察并比较两组患者心理护理前后的心理状态、生存质量及治疗依从性评分的变化情况。结果研究开始时不良状态组,心理状态评分明显高于正常状态组(P0.05);生存质量评分均明显低于正常状态组(P0.05);治疗依从性也明显比正常状态组差(P0.05)。经过3个月心理护理后,不良状态组患者心理状态评分明显降低(P0.05);生存质量评分均显著升高(P0.05);治疗依从性也明显得到改善(P0.05);正常状态组患者生存质量评分均显著升高(P0.05)。心理治疗后,两组患者的心理状态评分、生存质量评分比较,差异有统计学意义(P0.05);两组患者治疗依从性差异无统计学意义(P0.05)。结论心理护理能有效改善乙肝合并肝纤维化患者不良心理状态、生存质量和治疗依从性,提高患者治疗依从性,值得在临床上推广应用。     

个性化营养管理在慢性阻塞性肺疾病患者中的应用

目的 探讨个性化营养干预对慢性阻塞性肺疾病（COPD）患者的营养知信行水平、营养指标及活动耐力的影响。方法 选取我院2017 年1 月～2018 年12 月收治入院的COPD 患者224 例,用NRS 2002 对224 例COPD 住院患者进行营养风险筛查,其中存在营养风险者（NRS 2002≥3 分）68 例,按照入院先后顺序分为对照组和观察组,每组34 例,对照组给予常规饮食护理,观察组根据个体营养状况给予个性化营养管理,均持续干预1 个月。比较两组干预前后的营养知信行水平、营养指标及活动耐力的影响。结果 观察组在干预后其营养知信行水平、BMI、血清总蛋白（TP）、白蛋白（ALB）、淋巴细胞（LMP）数值及6 min 步行距离均显著高于对照组（P＜0.05）。结论 个性化营养干预能有效提高COPD 患者的营养知信行水平、提高营养指标、改善营养状况、增强活动耐力,从而提高生活质量。     

疏肝解郁内外合治对黄褐斑患者心理状况的影响

目的 探讨疏肝解郁内外合治对黄褐斑患者心理状况的影响。方法 选取2018 年1 月～2019 年12 月浙江中医药大学附属第三医院皮肤科门诊就诊的78 例气滞血瘀型黄褐斑患者,随机分观察组和对照组,治疗过程中脱落7 例,实际完成观察组35 例,对照组36 例,观察组给予疏肝活血汤联合外用中药祛斑霜,对照组给予氨甲环酸片联合外用维A 酸乳膏,治疗12 周进行皮损变化、临床疗效、不良反应、焦虑自评量表（SAS）及抑郁自评量表（SDS）评定。结果 基于皮损评分两组疗效比较,差异无统计学意义（P＞0.05）;两组治疗后皮损评分显著低于治疗前（P＜0.01）,且治疗后观察组SDS、SAS 评分显著低于对照组（P＜0.01）;观察组无明显不良反应。结论 两组治疗黄褐斑疗效相当,但疏肝解郁内外合治能显著改善患者心理状况,而且不良反应明显少于使用西药组。