Clinical Outcomes at 1 Year Following Transcatheter Left Atrial Appendage Occlusion in the United States

ObjectivesThe aim of this study was to report 1-year clinical outcomes following commercial transcatheter left atrial appendage occlusion (LAAO) in the United States.BackgroundThe National Cardiovascular Data Registry LAAO Registry was initiated to meet a condition of Medicare coverage and allow the assessment of clinical outcomes. The 1-year rates of thromboembolic events after transcatheter LAAO in such a large cohort of “real-world” patients have not been previously reported.MethodsPatients entered into the National Cardiovascular Data Registry LAAO Registry for a Watchman procedure between January 1, 2016, and December 31, 2018, were included. The primary endpoint was ischemic stroke. Key secondary endpoints included the rate of ischemic stroke or systemic embolism, mortality, and major bleeding. Major bleeding was defined as any bleeding requiring hospitalization, and/or causing a decrease in hemoglobin level > 2g/dL, and/or requiring blood transfusion that was not hemorrhagic stroke. The Kaplan-Meier method was used for 1-year estimates of cumulative event rates.ResultsThe study population consisted of 36,681 patients. The mean age was 76.0 ± 8.1 years, the mean CHA₂DS₂-VASc score was 4.8 ± 1.5, and the mean HAS-BLED score was 3.0 ± 1.1. Prior stroke was present in 25.5%, clinically relevant bleeding in 69.5%, and intracranial bleeding in 11.9%. Median follow-up was 374 days (IQR: 212-425 days). The Kaplan-Meier–estimated 1-year rate of ischemic stroke was 1.53% (95% CI: 1.39%-1.69%), the rate of ischemic stroke or systemic embolism was 2.19% (95% CI: 2.01%-2.38%), and the rate of mortality was 8.52% (95% CI: 8.19%-8.87%). The 1-year estimated rate of major bleeding was 6.93% (95% CI: 6.65%-7.21%). Most bleeding events occurred between discharge and 45 days following the procedure.ConclusionsThis study characterizes important outcomes in a national cohort of patients undergoing transcatheter LAAO in the United States. Clinicians and patients can integrate these data in shared decision making when considering this therapy.     

The correlations among racial/ethnic groups,hypertriglyceridemia, thrombosis,and mortality in hospitalized patients with COVID-19

Reports of racial and ethnic disparities regarding both rates of infection of the SARS-CoV-2 virus and morbidity of the coronavirus disease-19 (COVID-19) contain profound differences depending on the population. Our previous study has shown that patients with COVID-19 who developed hypertriglyceridemia during hospitalization have a 2.3 times higher mortality rate. However, whether the correlation between hypertriglyceridemia and mortality has disparity among different racial and ethnic groups is unknown.In this study, we investigated the impact of race/ethnicity on the correlation between hypertriglyceridemia and mortality in hospitalized patients with COVID-19. De-identified information from 904 hospitalized patients diagnosed with COVID-19 between March 2020 and June 2021 were extracted from the Medical College of Wisconsin Clinical Data Warehouse. A multivariable regression analysis suggested that the Asians and non-White Hispanics had 4 or 3.9 times higher mortality rate, respectively, after adjusting for age, morbid obesity (BMI ≥40), and gender. The hypertriglyceridemia (≥150 mg/dL) was associated with higher mortality, after adjusting for age, gender, and morbid obesity. The baseline hypertriglyceridemia occurrence had relevantly more consistent percentages among all racial/ethnic groups. However, non-White Hispanic and Asian patients had the highest frequencies of peak hypertriglyceridemia occurrence during hospitalization. The peak hypertriglyceridemia developed during hospitalization correlates with the incidence of thrombosis after adjusting for morbid obesity, age, and sex. In summary, in this retrospective study of 904 hospitalized COVID-19 patients, Asians and non-White Hispanics had a greater likelihood of developing hypertriglyceridemia during hospitalization and mortality than White patients.     

Pseudopolarography of trace metals. Part II. The comparison of the reversible,quasireversible and irreversible electrode reactions

The theoretical and experimental pseudopolarographic curves of reversible, quasireversible and irreversible electrochemical reactions were compared and evaluated. The measurements were performed on a stationary mercury drop electrode (SMDE, PAR 303A), using differential pulse anodic stripping voltammetry (DPASV). A good agreement between the theoretical and the experimental shift of the half-wave potential with an increasing accumulation time was obtained for the reversible pseudopolarograms of 10^?7 mol dm^?3 Cd(II) (in 0.1 mol dm^?3 NaClO₄, pH ～2). As compared with the curve of the logarithmic analysis of the polarogram, the corresponding curve of the pseudopolarogram is steeper in the region of the half-wave potential. It has been shown that even though the pseudopolarograms are quasireversible or irreversible, there is a range at the foot of the curves with a reversible slope (usually below 10% of the total/limiting current). It has been verified that the range of this reversible slope can be extended by increasing the accumulation time, lowering the mercury drop size and diminishing the thickness of the diffusion layer. The estimated value for its approximative evaluation is about 1% of the total/limiting current. This is essential for the determination of the corresponding electrochemical parameters, such as: the formal potential (E°^′), transfer coefficient (α) and rate constant (k_s). From the experimentally obtained reversible slope of the (pseudo)polarographic curves of Zn(II) (in 1 mol dm^?3 NaClO₄, pH 4.7 ± 0.1), the parameters for the quasireversible electrochemical reactions were estimated as follows: E°^′=?0.964 ± 0.002 V, α=0.24 ± 0.02 and k_s～2–3×10^?3 cm s^?1. It is shown that an accurate transfer coefficient can be calculated from the curves of the logarithmic analysis of the quasireversible pseudopolarograms, which is not the case for the polarographic curves. The irreversible system, tested on the electrochemical reaction of the CdNTA complex (in 0.1 mol dm^?3 NaClO₄, pH 7.9 ± 0.1), shows relatively good agreement between the experimental and the theoretical dependences. The (pseudo)polarographic measurements enabled approximate estimation of the electrochemical parameters (E°^′=?0.835 ± 0.010 V, α=0.55 ± 0.02 and k_s=1.0 ± 0.4 × 10^?4 cm s^?1) which are in fairly good agreement with the literature data.     

Power imbalance between nurses and patients: a potential inhibitor of partnership in care

The Patient's Charter identifies the need for nurses to respect patients' rights to influence their care, and contemporary nursing practice advocates that nurses work in partnership with patients. Hence nurses are encouraged to share their power and facilitate empowerment in their patients by giving them information and support. However, the literature indicates that nurses are not very successful in making patients feel empowered to make informed decisions. This study, conducted in 1998, provides some answers as to why this may be the case. The aim of the study was to explore and describe nurses' and patients' views regarding partnership in care in hospital. Using the grounded theory approach, participants were drawn from four hospitals in Western Australia. A purposive sample of 33 nurses and 32 patients were interviewed in-depth. Participant observation was also conducted and field notes were written. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings showed that nurses viewed involving patients in care as requiring them to give patients information and to share their decision-making powers with them. With the exception of a few, the majority of nurses were unwilling to share their decision-making powers. This created a situation of power imbalance with subsequent little patient input. Factors identified included nurses' beliefs that they "know best", the view that patients lacked medical knowledge and the perceived need for nurses to hold onto their power and maintain control. If nurses and patients are to work as partners, it is important that nurses make every effort to equalize the power imbalance. One way to do this is for nurses to share and give information to patients readily and to be open in their communication with them.     

纳洛酮治疗促进丘脑出血患者运动语言功能的恢复

目的:探讨纳洛酮对丘脑部高血压脑出血患者运动、语言功能的促进恢复作用。方法:44例丘脑部高血压脑出血并破入脑室内患者随机分成纳洛酮组和对照组,纳洛酮组22例,每天持续静脉注射纳络酮4.8mg,同时每天从脑室引流管中分10次共注入纳洛酮4mg,连续应用10d。对照组除未用纳洛酮外,其他治疗方法皆同纳洛酮组。同时观测两组患者第1,3,7,10天的哥拉斯格昏迷评分(GCS),代表患者的意识状况,大脑中动脉(MCA)的血流速度,血液流变学变化,血糖浓度,应激性溃疡发生率,语言和运动功能评分,哥拉斯格结局评分(GOS)评分。结果:纳洛酮组的GCS评分于第7天12.12±3.05,第10天12.66±3.25明显高于对照组10.23±4.01,10.89±4.21(P<0.05);纳洛酮组第3～7天内的MCA的平均血流速度、平均全血黏稠度和红细胞变形指数皆低于对照组(P<0.05);随访2个月时的运动、语言功能评分和GOS评分纳洛酮组皆高于对照组(P<0.05);纳洛酮组第7,10的血糖浓度低于对照组较接近正常值,应激性溃疡的发病率也较对照组低。结论:早期、多途径、大剂量应用纳洛酮能有效保护脑神经功能,降低机体损伤后应激反应的程度,促进脑神经功能的恢复。     

区域医疗卫生信息及影像数字化资源的共享战略

目的：探究区域医疗卫生信息及影像数字化资源共享的可持续发展途径。方法：直接走访和电话问卷调查作者所在省份44所医院相关信息,通过社区及公共传媒了解民众需求,对资源共享战略客观化分析。应用计算机检索中国期刊全文数据库(CNKI：2000/2010)、PubMed数据库等,检索词为“卫生信息,影像数字化,资源共享”和“medical treatment information, health information, images digitization”,语言分别设定为中文和英文,排除重复性研究及较陈旧的文献。结果：医院信息几乎全部得到反馈,大多数认识肯定,部分医院上层有顾虑,关键要地方政府支持,民众是绝对的拥护。网络专业数据库得到266篇文章,238篇由于时间久远与现状相距较大或重复性研究原因被排除,最后纳入28文章作为参考。根据国内外医疗卫生信息化发展现状,摸索区域医疗卫生信息数字化以人为本、科学、协调的可持续发展捷径,特别是影像数字化共享方式以及优缺点和可行性。结论：应该对区域医疗卫生信息进行全方位整合,实现资源共享,为民众提供高水平的卫生与健康信息服务,减少医疗经济支出,体现新医改以人为本的原则。     

Database Analysis of Simulated and Recorded Electrophysiological Datasets with PANDORA’s Toolbox

Neuronal recordings and computer simulations produce ever growing amounts of data, impeding conventional analysis methods from keeping pace. Such large datasets can be automatically analyzed by taking advantage of the well-established relational database paradigm. Raw electrophysiology data can be entered into a database by extracting its interesting characteristics (e.g., firing rate). Compared to storing the raw data directly, this database representation is several orders of magnitude higher efficient in storage space and processing time. Using two large electrophysiology recording and simulation datasets, we demonstrate that the database can be queried, transformed and analyzed. This process is relatively simple and easy to learn because it takes place entirely in Matlab, using our database analysis toolbox, PANDORA. It is capable of acquiring data from common recording and simulation platforms and exchanging data with external database engines and other analysis toolboxes, which make analysis simpler and highly interoperable. PANDORA is available to be freely used and modified because it is open-source (). Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

知识管理中的知识共享障碍因素

知识共享是知识创新的首要条件。然而在组织中,知识共享的障碍因素很多,主要包括知识共享主体、隐性知识本身、知识共享手段和知识共享环境四个方面。分析研究这些障碍因素,有针对性地采取相应措施,是组织开展知识管理的重要任务。     

医院药学质量管理体系建设与应用

目的：为建立标准化的医院药学质量管理体系提供参考。方法：运用多种管理方法,寻找现行质量控制工作中的薄弱环节,从确定改进内容、设计可行项目,到分步推进实施进行了论述。结果：通过建立标准化的质量管理体系,进一步完善了工作制度和操作规程,提升了药师职业素养,深化了药学服务内涵,医院药学管理水平得到了进一步提高。结论：标准化质量管理体系的建立改善了科室管理现状,使医院药学质量管理更趋于规范、合理,经验值得借鉴。