Changes in the National Endovascular Management of Femoropopliteal Arterial Disease: An Analysis of the 2011–2019 Medicare Data

PurposeTo describe national trends in the utilization of endovascular approaches (including balloon angioplasty, atherectomy, and stent placement) for the management of femoropopliteal peripheral arterial disease (PAD).Materials and MethodsThe Medicare Physician/Supplier Procedure Summary dataset containing 100% of Part B claims was interrogated for years 2011–2019. The Current Procedural Terminology codes specific for femoropopliteal angioplasty, stent placement, and atherectomy were used to create summary statistics for utilization by year, place of service (hospital inpatient, hospital outpatient, and office-based laboratory), and provider specialty (cardiology, radiology, and surgery).ResultsThe use of atherectomy increased from 34,732 (33%) procedures in 2011 to 75,435 (53%) procedures in 2019, and atherectomy became the dominant treatment strategy for femoropopliteal PAD. The relative utilization of stent placement (36,793 [35%] to 28,899 [20%]) and angioplasty only (34,398 [32%] to 38,228 [27%]) decreased concomitantly from 2011 to 2019. By 2019, the use of atherectomy was twofold higher in office-based laboratories than in the outpatient hospital setting (44,767 and 20,901, respectively). Treatment strategy varied by provider specialty in 2011 when cardiologists used atherectomy most frequently (17,925 [43%]), whereas radiologists used angioplasty alone (5,928 [6%]) and surgeons stented (18,009 [37%]) most frequently. By 2019, all specialties utilized atherectomy most frequently (29,564 [59%] for cardiology, 10,912 [58%] radiology, and 33,649 [47%] surgery).ConclusionsThe national approach to endovascular management of femoropopliteal PAD has changed since 2011 toward an implant-free strategy, including a multifold increase in the use of atherectomy. Discordant rates of atherectomy use between the ambulatory hospital and office-based settings highlight the need for comparative effectiveness studies to guide management.     

Association between first oral examination characteristics and dental treatment needs in privately insured children: A claims data analysis

BackgroundEarly childhood caries (ECC) remains the most common, preventable infectious disease among children in the United States. Screening is recommended after the eruption of the first tooth, but it is unclear how the age at first dental examination is associated with eventual restorative treatment needs. The authors of this study sought to determine how provider type and age at first dental examination are associated longitudinally with caries experience among children in the United States.MethodsDeidentified claims data were included for 706,636 privately insured children aged 0 through 6 years as part of the nationwide IBM Watson Health Market Scan (2012-2017). The authors used Kaplan-Meier survival analysis to describe the association between the age of first visit and restorative treatment needs.ResultsA total of 21% of this population required restorative treatment, and the average age at first dental examination was 3.6 years. A multivariable Cox proportional hazards model showed increased hazard for restorative treatment with age at first dental visit at 3 years (hazard ratio, 2.05; 95% CI, 1.97 to 2.13) and 4 years (hazard ratio, 3.99; 95% CI, 3.84 to 4.16).ConclusionThe high proportion of children requiring restorative treatment and late age at first dental screening show needed investments in educating general dentists, medical students, and pediatricians about oral health guidelines for pediatric patients.Practical ImplicationsCommunicating the importance of children establishing a dental home by age 1 year to parents and health care professionals may help reduce disease burden in children younger than 6 years.     

大学生的人工流产现状、认知与态度调查分析

目的:了解大学生的人工流产现状、认知与态度。方法:采用随机抽样,对福建924名在校大学生进行无记名问卷调查。结果:有人工流产经历的占有过性经历的10.3%,其中有7人(25.9%)不是在正规医疗场所进行人工流产。大学生对负压吸引术(17.8%)、钳刮术(38.3%)的知晓率较低,知道人工流产可能引起宫颈和宫腔粘连、盆腔感染、宫外孕等疾病的人不到一半。有250人(27.0%)对朋友的人工流产经历表示不同程度的介意,对伴侣的人流经历有表示介意多达880人(95.2%),显示出大学生在思想上比较介意人流经历,并且对不同对象双重标准的矛盾心理。男生对人工流产的认知度和宽容度均低于女生,有性经历者对人工流产的认知度低于无性经历者,而宽容度却高于无性经历者。大学生渴望通过学校生殖健康课和社区教育得到相关知识。结论:大学生在人工流产方面的认知有较大欠缺,需要学校、社区、家庭进行系统科学的教育以降低大学生人工流产发生率。     

新型冠状病毒肺炎疫情期间发热门诊的护理管理

新型冠状病毒肺炎疫情防控期间,发热门诊作为疾病诊治的重点部门,其防护工作是保障医护人员安全工作的重中之重,防护用品的使用、诊治流程以及呼吸机操作等环节的护理管理均要严格规范化、科学化。     

Effect of transspinal direct current stimulation on afferent pain signalling in humans

Anodal transspinal Direct Current Stimulation (tsDCS) has been suggested as a means to treat neuropathic pain by reducing pain signalling/processing and Laser Evoked Potentials (LEPs) likewise as a method to evaluate such reduction. However, results in previous studies are disagreeing. To evaluate these claims using rigorous methodology, LEPs were evoked from hands and feet in healthy volunteers. The N2 potential and three psychophysic parameters (general- and pinprick pain, warmth) were used to evaluate the signalling and appreciation of pain respectively. This was made at three time points; at baseline, directly- and 30 min after low thoracic tsDCS (20 min, 2.5 mA, cathode on shoulder). The study was randomized, cross over, double blinded and placebo controlled.At the group level, low thoracic anodal tsDCS produced reduced perceptions of all three tested pain qualities from the foot (p < 0.05 – p < 0.001). These reductions began during stimulation and became more pronounced during the 30 min after its cessation (p < 0.05 – p < 0.01). The LEP parameter alteration mirroring these changes was latency prolongation (p < 0.05 – p < 0.001) whereas amplitude reductions were in par with placebo stimulation. Similar but less pronounced and only transient (during stimulation, p < 0.05 – p < 0.001) changes, were seen for hand stimulation. The interindividual variation was large.The findings indicate that anodal tsDCS may become a technique to treat neuropathic pain by reducing pain signalling/processing and LEPs likewise a method to evaluate such reduction.     

奇异变形杆菌耐药性研究进展

奇异变形杆菌是临床重要的条件致病菌,可以引起消化道、泌尿道等各种类型的感染。其导致的感染尤其是尿路感染病情严重、持久难治。近年来,有关奇异变形杆菌的耐药报道日益增多,其耐药性呈上升趋势。本研究主要从奇异变形杆菌对-内酰胺类、喹诺酮类等常见抗菌药物的耐药性着手,通过描述其生物学特征、耐药机制、主要耐药基因类型及流行情况、临床感染及治疗情况、未来发展趋势5个方面来介绍奇异变形杆菌耐药性的研究进展。     

PBL教学法在核医学理论教学中的应用研究

目的探讨PBL教学法在核医学理论教学中的应用效果。方法选取我院2019年9月—2020年10月参加核医学课程学习的医学专业的本科学生92名,用随机数字法分为对照组和研究组,每组各46名,对照组应用传统教学法,研究组应用PBL教学法。对两组学习情况(理论知识、阅片能力、临床技能)、教学效果满意度以及自评评价(有无提高自身学习主动性、有无提高自身表达能力、有无提高自身查阅文献的能力、有无增强自身对于影像诊断的分析和思维能力)进行比较。结果研究组学习情况优于对照组,差异有统计学意义(P<0.05)。研究组教学效果满意度高于对照组,差异有统计学意义(P <0.05)。研究组自评评价优于对照组,差异有统计学意义(P <0.05)。结论在核医学理论教学中,应用PBL教学法,有效提高教学效果,加强学生对理论知识的记忆,具有可行性,同时,增强学生的综合素质,并提升临床综合能力,值得在临床上进一步推广应用。     

Selective Mapping of Deep Brain Stimulation Lead Currents Using Acoustoelectric Imaging

We describe a new application of acoustoelectric imaging for non-invasive mapping of the location, magnitude and polarity of current generated by a clinical deep brain stimulation (DBS) device. Ultrasound at 1MHz was focused near the DBS device as short current pulses were injected across different DBS leads. A recording electrode detected the high-frequency acoustoelectric interaction signal. Linear scans of the US beam produced time-varying images of the magnitude and polarity of the induced current, enabling precise localization of the DBS leads within 0.70mm, a detection threshold of 1.75mA at 1 MPa and a sensitivity of 0.52 ± 0.07 μV/(mA*MPa). Monopole and dipole configurations in saline were repeated through a human skullcap. Despite 13.8-dB ultrasound attenuation through bone, acoustoelectric imaging was still >10dB above background with a sensitivity of 0.56 ± 0.10 μV/(mA*MPa). This proof-of-concept study indicates that selective mapping of lead currents through a DBS device may be possible using non-invasive acoustoelectric imaging.     

Longitudinal outcomes of using a fluoride performance measure for adults at high risk of experiencing caries

BackgroundStaff of the VA Office of Dentistry, the dental care arm of the U.S. Department of Veterans Affairs' Veterans Health Administration, developed a performance measure (PM) regarding appropriate fluoride use. The authors hypothesized that after the implementation of this PM, veterans at high risk of experiencing caries would require fewer new dental restorations than in the past.MethodsIn a retrospective longitudinal analysis, the authors evaluated the effectiveness of a PM in reducing restoration rates in veterans at high risk of experiencing caries. They evaluated changes in restoration rates for all eligible veterans, as well as the subpopulation at high risk of experiencing caries (defined as receiving two or more restorations in 12 months) both before and after the implementation of the PM.ResultsIn 2012, 81 percent of clinics provided fluoride for more than 90 percent of their patients at high risk of experiencing caries. After use of the PM for four years, there were 8.6 percent fewer patients needing two or more restorations, a 10.8 percent decrease in the mean number of restorations and a modest 3.4 percent fewer patients at high risk of experiencing caries who required new restorations after the initial 12-month period.ConclusionsFluoride use for patients at high risk of experiencing caries rose from 51.8 percent in 2008 to 93.6 percent in 2012. Restoration rates rose before implementation of the PM and fell consistently after its implementation.Practical ImplicationsFluoride use reduces the need for future restorations in adults at high risk of experiencing caries.