Gender differences in the management and survival of patients with acute myocardial infarction

Coronary heart disease (CHD) and specifically acute myocardial infarction (AMI) are the most common causes of death among both men and women throughout the world. Although CHD mortality rates have been halved in many developed countries in recent decades, some studies have pointed out significant differences regarding time-related tendencies of mortality between the sexes. This paper briefly reviews factors related to post-AMI survival and possible reasons for inequalities in survival benefit between men and women after AMI. Presentation of AMI also exhibits differences with regard to sex, and this has some effect on patient care and on mortality from the disease. CHD morbidity and mortality rates vary with socioeconomic deprivation and social patterning in most industrialized countries. Several studies have indicated that women sustaining AMI have a higher mortality than men. Although AMI affects men in greater numbers, the short-term outcomes for women are worse. Studies suggest that, over the longer term, the mortality risk for women is lower than, or similar to, that for men. It is still a major problem that in-hospital case fatality and morbidity rates in the post-infarction period are higher for women, despite lower rates of administration of thrombolytics and catheterization. Patients admitted to the hospital with an AMI should be offered optimal treatment, irrespective of age or sex.     

Frequency of thromboprophylaxis and incidence of in-hospital venous thromboembolism in a cohort of emergency department patients

Objective Prior work suggests that in-hospital pulmonary and venous thromboembolism (VTE) could be decreased if the rate of prophylaxis for VTE in high-risk patients were increased at the time of admission. Our objective was to quantify the rate of thromboprophylaxis and incidence of in-hospital VTE, based upon risk of VTE, in a cohort of patients admitted through the emergency department (ED). Methods We performed a prospective cohort study at an urban ED with >100,000 visits. All medical patients >17 years admitted from the ED were prospectively identified on a random sample of days for one year. Using a structured data form we collected each patient’s risk factors for VTE, and prophylaxis measures. We computed a validated risk score of each patient, with a score ≥4 high-risk (HR) and a score <4 low risk (LR). The main outcome was VTE during the hospitalization, diagnosed after admission from ED. Results Of 4732 patients, VTE was diagnosed during hospitalization in 44 (0.9%). 437 (9%) patients were HR for VTE and HR patients had significantly higher frequency of VTE vs. LR patients, 1.8 vs. 0.8% (95% CI for difference of 1% = 0.1–3%). Only 36% of HR patients received thromboprophylaxis. There were no significant differences in the frequency of observed inpatient VTE events between patients who were prescribed prophylaxis compared with those who were not prescribed prophylaxis in either risk group. Conclusion These data suggest only a modest opportunity for ED-based policy for thromboprophylaxis in admitted medical patients.     

Determination of the cutoff values of Th2 markers for the prediction of future exacerbation in severe asthma: An analysis from the Hokkaido Severe Asthma Cohort Study

BackgroundWe recently reported that severe asthma patients with frequent exacerbations showed high blood eosinophil counts (Eo) and fractions of exhaled nitric oxide (FeNO) compared with non-exacerbators. However, we did not determine exact cutoff values related to exacerbation. The aim of this study was to determine the cutoff values of Eo and FeNO that could be related to the exacerbation of severe asthma. We also aimed to confirm the clinical utility of Th2 markers related to exacerbation.MethodsThis study included 105 severe asthma patients who completed a three-year follow-up of a severe asthma cohort study, including smokers. Three Th2 markers were selected, viz., Eo, FeNO, and positive atopic status. Regarding Eo and FeNO, we determined the cutoff values for the definition of “positive” Th2 features using receiver operating characteristic curve analyses, based on the comparisons between frequent exacerbators and other patients.ResultsThe cutoff values for positive Th2 features were Eo ≥ 250 cells/μL and FeNO ≥31 ppb. Sixteen patients (15.2%) had no Th2 features, 40 (38.1%) had one, 25 (23.8%) had two, and 24 (22.9%) had three. A high number of positive Th2 features was significantly associated with exacerbation frequencies over three years (p < 0.05). Similarly, compared to patients with one or no Th2 features, those with three Th2 features had a significantly higher probability of having more than one exacerbation (p < 0.05).ConclusionsThe cutoff values determined in the current analysis were good predictors of future exacerbations in severe asthma patients.     

Surveillance of the use of adrenaline auto-injectors in Japanese children

Background

The appropriate usage of an adrenaline auto-injector (AAI, Epipen^®) is a key aspect of patient and social education in the management of anaphylaxis. However, although AAIs are being prescribed increasingly frequently, there are few reports on their actual use.

皮肤科医学留学生带教方法探析

医学留学生英语发音较重、母语口音明显;基础水平参差不齐;学习主动性高,课堂思维活跃;留学生之间文化背景差异较大.针对教学中存在的语言沟通障碍导致的师生交流问题、缺乏统一教材影响教学效果、语言交流不畅阻碍留学生与患者沟通等问题,采取编撰或选择适宜的教材;提高教师英语水平以避免师生交流障碍;使用多媒体方式提高教学效果;应用PBL教学模式和小组协作的方式调动学生的积极性;平时成绩与期末成绩相结合的考核方法等方式,探索更有效的留学生见习教学方法.     

循证护理在眼科临床教学中的应用

目的：评价循证护理在眼科临床教学中的效果。方法将2011年4月至2012年3月在西南医院眼科参加临床实习的50名护生按照专科生、本科生数目对等的方法,随机分为对照组和实验组,对照组给予传统眼科护理教学,实验组在此基础上采用循证的方法实施护理带教。实习结束后对2组护生采用问卷评分和出科考试评价实施效果。采用Excel 2003软件整理数据,用SPSS 13.0软件进行统计分析,对问卷评分进行χ2检验;以≥60分的人数作为有效的指标,对两组学生出科考试成绩行t检验,以P〈0.05为差异有统计学意义。结果实验组问卷评分60以上人数均多于对照组,差异具有统计学意义（χ2=6.818, P=0.018）。对照组理论考试平均成绩（67.12±11.53）分,实验组理论考试平均成绩（84.96±9.27）分;对照组实践操作考试平均成绩（65.68±8.0）分,实验组实践操作考试平均成绩（80.28±10.65）分,2组比较差异均有统计学意义（P值均等于0.000）。结论眼科临床教学中采用循证护理干预,能使护生在眼科护理实习期间学会思考,善于查阅文献,敢于用批判的思维提出问题,能够以科学研究结果及亲身经验作为依据,掌握专业、科学的眼科护理,从而提高护理实践能力。     

间歇性肿瘤细胞减灭术治疗晚期卵巢上皮性癌治疗中的疗效探讨

目的:探讨间歇性肿瘤减灭术在晚期卵巢上皮性癌治疗中的临床价值。方法:将我院收治的68例卵巢上皮性癌患者随机分为观察组和对照组,观察组采用间歇性肿瘤减灭术治疗,对照组采用辅助化疗治疗,对比两组患者的治疗前后的临床特征及术后生存状况。结果:观察组的手术时间、住院时间、术中出血量明显优于对照组,术后3年生存率和5年生存率明显高于对照组。结论:间歇性肿瘤细胞减灭术提高卵巢上皮性癌的治疗效果,延长患者生命,具有较高的临床应用价值。     

心内科教学模式在临床基地规范化培训中的探索

CBL教学法是一种情景模式的案例导向式教学模式,科室查房是一项例行性的医疗制度。本文作者提出在临床基地规范化培训当中,将CBL教学法和科室查房制度相结合,设计出一套使医学生、临床医师和科室三方在教学培训过程中相互受益的心血管内科教学模式。     

橄榄油脂肪乳在肠外营养中的研究和临床应用进展

脂肪乳作为肠外营养支持中主要的能量来源,20世纪60年代以来,已发展出多种不同配方的制剂。目前在临床上应用的主要为大豆油长链(LCT)和中长链(MCT/LCT)脂肪乳,大豆油LCT和MCT/LCT脂肪乳对免疫功能的抑制及其对肝功能的影响也越来越被人们所认识。橄榄油脂肪乳由橄榄油和大豆油以4∶1的比例混合而成,其多不饱和脂肪酸含量很低,富含单不饱和脂肪酸。橄榄油脂肪乳对免疫细胞功能和肝功能的影响更小,其效能已在多项临床试验中得到验证。     

消化科内镜治疗患者对医师性别选择的影响因素研究

目的：探讨消化科内镜治疗患者医师的性别选择及其影响因素,以期为提高患者治疗的依从性等提供依据。方法：选择2008年1月至2013年1月我院收治的消化科实施內镜治疗的患者80例为研究对象,采用自制的《消化科内镜治疗患者对医师性别选择影响因素调查表》对80例例消化道疾病患者实施问卷调查,采用logistic回归法对影响患者对医师性别选择的相关因素进行统计学分析,观察各因素与医师性别选择的相关性。结果：单因素分析结果显示性别、年龄、疾病类型与患者对医师性别的选择具有显著的相关性（P〈0.05）,而职业、收入、受教育状况与患者对医师性别的选择无相关性（P〉0.05）;logistic多因素回归分析结果显示性别（X2=6.799,P=0.009,95%CI1.303-6.467）、疾病类型（X2=6.136,P=0.013,95%CI1.227-5.783）是影响患者对医师性别选择的主要因素,具有统计学意义（P〈0.05）。结论：性别、疾病类型是影响患者对医师性别选择倾向的主要因素,因此医院在医师性别上要合理的配置,尽量满足患者的需求,进而提高患者治疗的依从性。