Implementation of Goals of Care Communication Innovation Among Nursing Homes: A Multiple Case Study Design

ObjectiveNursing homes (NHs) provide care to residents with serious illness and related complex health care needs. As such, discussions about end-of-life care between NH staff and residents and families are necessary to ensure residents receive care consistent with their goals. Interventions such as video decision aids have been developed to promote discussions and improve advance care planning, but few studies have examined how NH characteristics may relate to the implementation of these interventions; such information might lead toward more use of successful interventions. The purpose of this study is to understand NH characteristics that are associated with the implementation of the Goals of Care (GOC) intervention, which combined a video decision aid with a structured discussion to guide decision-making in advanced dementia.DesignA multiple case study.Setting and ParticipantsStaff surveys were conducted to examine factors related to implementation effectiveness in 11 NHs in North Carolina that participated in the GOC trial.MethodsQuestions measured the dependent variable of implementation effectiveness: the consistency and quality of use of the GOC intervention. NH organizational characteristics were measured using publicly available data and an administrator survey. The analysis consisted of pattern matching logic.ResultsHigh management support aligned with implementation effectiveness within NHs. In addition, the within case pattern analysis indicated additional characteristics related to implementation effectiveness. Facility size, Medicare beds, residents’ racial composition, and star rating were related to implementation effectiveness across 6 of the 11 NHs. NH financial resources, such as size and number of Medicare beds, may be important factors for successful implementation.Conclusion and ImplicationsNHs seeking to implement advance care planning interventions should focus on within and across NH differences, such as adequate management and financial support prior to implementation to increase the likelihood of implementation effectiveness.     

肥胖低通气综合征致急性呼吸衰竭临床分析

目的：阐明肥胖低通气综合征（OHS）所致急性呼吸衰竭的临床特点。方法：对8例OHS致急性呼吸衰竭患者的临床和实验室检查资料进行分析.结果：7例男性和1例女性患者均表现为肥胖,体重指数（BMI）女性为38．79kg.m^-2,男性平均42．68kg.m^-2,年龄平均62岁。全部患者均表现有呼吸性酸中毒,平均pH7.19,平均动脉血二氧化碳分压（PaCO2)12.35kPa,平均动脉血氧分压（PaO2)5.40kPa.8例肺功能检查显示第1秒用力呼气容积实测值占预计值的百分比（FEV1％）为78．75％,肺活量实测值占预计值的百分比（VC％）为78．80％,经治疗后PaCO2为6．49kPa,PaO2为11．42kPa,结论：OHS导致急性呼吸衰竭发生快,表现多样,肺功能损害轻,治疗及时则预后较好。     

Retrosigmoid Approach in the Supine Position Using ORBEYE: A Consecutive Series of 14 Cases

One of the merits of recently introduced exoscopes, including ORBEYE, is that they are superior to a conventional microscope in terms of ergonomic features. Taking advantage of it, the retrosigmoid approach can be performed in the supine position using ORBEYE. We report a consecutive series of 14 operations through the retrosigmoid approach in the supine position using ORBEYE. Fourteen consecutive patients who underwent surgery through the retrosigmoid approach for cerebellopontine (CP) angle lesions in the supine position using ORBEYE were targeted, and surgical outcomes and complications were examined. We evaluated the posture of the operator and the surgical field during this approach compared with those using a conventional microscope. In all 14 cases, all operative procedures were accomplished only using the ORBEYE. There were no operative complications due to this approach. Using ORBEYE, even when the angle of the operative visual axis was horizontal, the operators could manipulate in a comfortable posture. They were not forced to be in an uncomfortable posture that extended their arms, as is often the case with a conventional microscope. Therefore, they could use shorter surgical instruments. As the cerebellum shifted downward with gravity even using slight retraction during this approach, the working space of the surgical field was easily secured. Through this approach, the operators can perform stable microsurgery of CP angle lesions in a comfortable posture. This approach can reduce the burden on the operator and the patient, leading to a refined surgical procedure.     

Sandwich联合案例教学法在神经内科临床实习中的应用

目的 探讨Sandwich联合以案例为基础的教学法在神经内科临床实习中的应用效果,为进一步优化教学方法提供参考.方法 以98名神经内科实习护理本科生为对象,按照实习病区分为对照组与观察组各49名.对照组采用传统教学法进行教学,观察组在对照组基础上采用Sandwich联合以案例为基础的教学法.出科前比较两组理论考试成绩及对教学方法的评价.结果 观察组理论考试成绩及教学满意评分显著高于对照组(P＜0.05,P＜0.01).结论 Sandwich联合以案例为基础的教学法可有促进学生对理论知识的掌握,提高教学效果.     

应用CiteSpace软件对腹腔镜肝切除术文献行可视化分析报告

Visual analysis of laparoscopic hepatectomy by CiteSpace software        LIU Yao*,CAO Kuan,ZHANG Bin,et al. *Graduate School of Xuzhou Medical University, Xuzhou 221004,China Corresponding author：WANG Ren-hao, E-mail:wangrenhao@xzhmu.edu.cn Abstract    Objective    To analyze the papers,research hotspots and research trends in the research field of laparoscopic hepatectomy,so as to provide references for relevant personnel in this field to carry out the academic research of laparoscopic hepatectomy.  Methods    In the web of Science（WOS）,take " laparoscopic liver resection " as the subject word, "August 20,2021" as the time node,and "paper or review" as the source to limit the type of journals. Use Excel to sort out the retrieved documents,and get the basic overview of the annual number of documents,countries or regions,periodicals,institutions and authors. Use CiteSpace to perform keyword cluster analysis,and obtain the research hotspot and development trend. Results    A total of 2792 articles were retrieved,the total number of publications was small,  but the annual publication volume showed an increasing trend. Literature sources were highly concentrated in a few countries or regions. More than 100 articles in this field were published by 3 journals. More than 100 documents issued by 3 issuing institutions. More than 50 articles issued by 10 people. The research hotspots in this field focused on radiofrequency ablation,liver surgery,cholecystectomy,liver transferase and surgical management. From the evolution trend of research topics from 2002 to 2021,partial hepatectomy,ultrasonography,cancer cells,malignant tumors,liver tumors,laparoscopic cholecystectomy,bile duct injury,radiofrequency ablation of liver metastasis,surgical management,diagnostic laparoscopy,single center,meta-analysis and outcm are the frontier topics in this field,it may become the focus of scholars' attention in the next few years. Conclusion    Laparoscopic hepatectomy has been widely used all over the world because of its advantages of small trauma and rapid recovery. In the future,it is necessary to pay attention to the cutting-edge research in this field and explore new surgical methods on the existing basis.     

基于CiteSpace的近5年国内外男性骨质疏松症研究热点可视化分析

目的 对比近5年男性骨质疏松症国内外研究现状、热点。方法 以中国知网（CNKI）、Web of Science（WOS）核心合集数据库为数据来源,利用CtieSpace,v.5.6.R1对近5年男性骨质疏松症文献进行可视化分析。结果 共纳入中文文献552篇、英文文献3632篇,针对男性骨质疏松症领域的研究主要国家为美国、英国、法国、澳大利亚,主要期刊为Journal of Bone and Mineral Research、Osteoporosis International、Bone。与国外相比,国内机构之间、作者之间缺乏合作。国内外男性骨质疏松症的研究在骨质疏松症的病因、危险因素、实验室检查、影像学检查、治疗药物、骨折风险评估等基础上,以药物治疗、疾病筛查、骨折风险评估等方面为研究热点,就骨质疏松症预防与骨折风险评估而言,国内外研究方向大致相同。在药物治疗方面,国外对新型抗骨质疏松药物的研究较国内更深入。结论 在我国未来男性骨质疏松症的相关研究中,多中心、机构、作者之间的合作有助于研究领域的发展,同时也需更进一步开展骨质疏松性骨折评估、预防、新型抗骨质疏松药物等研究。     

Pseudoangiosarcomatous squamous cell carcinoma: first case report on penis

Pseudoangiosarcomatous squamous cell carcinoma, also called pseudovascular, pseudoangiomatoid or adenoid pseudovascular carcinoma, is an uncommon and highly aggressive variant of squamous cell carcinoma. Histologically, it is characterized by proliferation of atypical keratinocytes with acantholysis and formation of pseudovascular spaces, forming anastomosed channels lined with neoplastic cells that invade the dermis. These cells are positive for cytokeratin and negative for vascular markers such as CD31 and CD34. There are few reports of this variant in the literature. Skin, breast, lung and vulva involvement have been described, but to the best of our knowledge, no cases involving the penis has been described. This study aims to describe the first case of angiosarcomatous squamous cell carcinoma of the penis. The patient presented with a painful lesion in the penis associated with urinary retention. Macroscopic findings exhibited an ulcerative vegetating lesion that involving the entire glans and part of the penile body, as well as infiltration of penile structures and scrotal skin. Microscopy shows atypical proliferation of sarcomatous keratinocyte pattern mimicking vascular spaces. Human papilloma virus (HPV) biomarkers and polymerase chain reaction (PCR) were all negative. Advanced penile squamous cell carcinoma with aggressive lymph node metastasis. This report presents the first case of penile pseudoangiosarcomatous squamous cell carcinoma, as an important differential diagnosis.     

Functional paraganglioma with tumor thrombus in the inferior vena cava,first case report

Pheochromocytoma (PHEO) is a rare neuroendocrine that tumor originated from the adrenal medulla that secrets catecholamines. Tumors from extra-adrenal chromaffin tissues are called extra-adrenal PHEO or paraganglioma (PGL). To our knowledge, adrenal PHEO and subclinical PGL with inferior vena cava (IVC) invasion had been sporadically reported, while functional PGL with IVC tumor thrombus has not been publicly reported yet. Perioperative management of those diseases is less well established because of their multidisciplinary nature and rarity. We herein present a case of primary malignant PGL with IVC invasion. A 16-year-old female patient with a history of severe paroxysmal hypertension was admitted to Peking Union Medical College Hospital on suspicion of retroperitoneal mass. In-house diagnostic work-up revealed a malignant PGL with IVC invasion, inferior mesenteric artery encasement and, aorta engagement. Multi-disciplinary discussions were held and careful preoperative preparation plans were made. After everything was ready, the functional PGL and tumor thrombus were completely resected, then a reconstruction of IVC was performed. The patient was discharged on postoperative day 14 and all her clinical symptoms disappeared afterward. No evidence of tumor residual or metastasis was found in the subsequent six months of follow-up. Gene tests were made for her and her family. Albeit its rarity, functional PGL with IVC invasion is not unresectable, a multi-disciplinary task force should be established to settle down every detail. We recommended 3-dimensional imaging reconstruction for gaining a better anatomic understanding. Literature reviews showed that complete resection is the premise of a good prognosis. In particular cases, complementary or alternative therapy like chemotherapy and ¹³¹I-metaiodobenzylguanidine might help, family hereditary genetic tests are advised as well.     

Transurethral Foley catheter misplacement into the upper urinary tract in a patient with a history of lung cancer and chemotherapy: a case report and considerations to keep in mind

Indwelling urethral catheter placement is a common and comparatively safe procedure. Misplacement of a urethral catheter into the upper urinary tract is unusual, and only a few cases have been reported. We describe the case of a 43-year-old man who presented with oliguria and had a history of chemotherapy for known metastatic lung cancer. As he had no history of urological disease, urethral catheterization was expected to be uneventful. The catheter was unable to be pulled back to the bladder neck once the balloon was inflated, and the patient expressed discomfort. Subsequent computed tomography revealed that the tip of the catheter was placed in the middle of the right ureter. Unbeknownst to the physicians before urethral catheterization, the patient had severe lower urinary tract symptoms and urinary bladder dysfunction with hydronephrosis, likely due to chemotherapy. Based on the patient’s symptoms and imaging results, we judged the possibility of severe ureteral injury to be low. The malpositioned catheter was removed uneventfully after complete balloon deflation and then reinserted properly. He was admitted to the medical department but died as a result of an exacerbation of the underlying disease unrelated to the incident. If urethral catheter placement seems abnormal, physicians should aspirate and irrigate to confirm correct positioning before balloon inflation; then, they should carefully pull the inflated balloon near the neck of the bladder while monitoring the patient’s symptoms. Although urethral catheter placement is comparatively safe, physicians must keep in mind that patients who have undergone chemotherapy might be at a risk for this rare complication.     

A “bridge” technique to replace the obstructed single-J stent in the patient with ileal conduit urinary diversion: a case report

The ureteroileal anastomotic stricture is a complication of ileal conduit urinary diversion. To prevent the hydronephrosis and protect the renal function, a single-J ureteral stent may be needed. However, the most common complication of these patients is single-J stent obstruction. To solve this problem, we describe an easy, useful and low-cost technique to replace the obstructed ureteral stent under radiographic guidance without intervention by flexible cystoscopy or percutaneous nephrostomy. The key steps of our procedure are to identify the location of the stricture, to place the super smooth guide wire into pinhole of the obstructed single-J stent and to get the super smooth guide wire and 5-Fr ureteral catheter across the stricture. Our case was a 40-year-old male patient who was diagnosed as pelvic lipomatosis and received ileal conduit urinary diversion 3 years ago. The left-side ureteroileal anastomotic stricture occurred 1 year after surgery. He refused to repair the stricture by open or other minimal invasive surgery. He regularly changed his ureteral stent with intervals of three months. As the stent was obstructed by the stone, the guide wire couldn’t be inserted through the primary ureteral stent. We used our “bridge” technique to solve his problem successfully. No bleeding and no urinary tract infection were observed after intervention. The urine from the ureteral stent was fluent. We think that this “bridge” technique may be a good choice for the replacement of the obstructed single-J stent in the patients of ileal conduit urinary diversion.