Uso de la infusión intestinal continua de levodopa-carbidopa en pacientes con enfermedad de Parkinson avanzada en España. Subanálisis por comunidades autónomas

ObjectivesTo compare the characteristics of patients undergoing treatment with continuous intestinal infusion of levodopa-carbidopa (CIILC) for advanced Parkinson's disease and the data on the effectiveness and safety of CIILC in the different autonomous communities (AC) of Spain.MethodsA retrospective, longitudinal, observational study was carried out into 177 patients from 11 CAs who underwent CIILC between January 2006 and December 2011. We analysed data on patients’ clinical and demographic characteristics, variables related to effectiveness (changes in off time/on time with or without disabling dyskinesia; changes in Hoehn and Yahr scale and Unified Parkinson's Disease Rating Scale scores; non-motor symptoms; and Clinical Global Impression scale scores) and safety (adverse events), and the rate of CIILC discontinuation.ResultsSignificant differences were observed between CAs for several baseline variables: duration of disease progression prior to CIILC onset, off time (34.9-59.7%) and on time (2.6-48.0%; with or without disabling dyskinesia), Hoehn and Yahr score during on time, Unified Parkinson's Disease Rating Scale-III score during both on and off time, presence of ≥ 4 motor symptoms, and CIILC dose. Significant differences were observed during follow-up (> 24 months in 9 of the 11 CAs studied) for the percentage of off time and on time without disabling dyskinesia, adverse events frequency, and Clinical Global Impression scores. The rate of CIILC discontinuation was between 20-40% in 9 CAs (78 and 80% in remaining 2 CAs).ConclusionsThis study reveals a marked variability between CAs in terms of patient selection and CIILC safety and effectiveness. These results may have been influenced by patients’ baseline characteristics, the availability of multidisciplinary teams, and clinical experience.     

New method to differentiate surface damping behavior and stress absorption capacities of common CAD/CAM restorative materials

ObjectivesTo assess energy dissipation capacities and surface damping abilities of different CAD/CAM restorative materials (CRMs) to characterize stress resistance during load peaks.MethodsUsing instrumented indentation testing (IIT), Martens hardness (HM) together with its elastic (η_IT) and plastic index (η_ITdis) and Leeb hardness (HLD) together with its deduced energy dissipation (HLD_dis) were determined for eight ceramic, eight composite, and four polymer-based materials as well as three metals. The results were compared to those of bovine enamel. Ten indentations per material were performed at room temperature (23 ± 1 °C) on two separate specimens (12.0 × 12.0 × 3.5 mm³) after water storage (24 h; 37.0 ± 1.0 °C). Hardness parameters were recorded, and data were analyzed with one-way MANOVA (Games-Howell post hoc tests, α = 0.05). Correlations between different parameters were tested (Pearson, α = 0.05).ResultsIndependently determined HLD_dis, and η_ITdis values substantiated different energy dissipation characteristics of CRM, whereby a strong correlation was observed for the two datasets (r = 0.956, p = 0.011). Ceramics had the significantly lowest values (p < 0.001) while both parameters revealed the highest surface damping effects for metals (p < 0.001), followed in both cases by bovine enamel. Energy dissipation of polymer and composite CRM was in between ceramics and bovine enamel (p < 0.001), whereas only for HLD_dis did both show no significant difference (p > 0.05).SignificancePromising new HLD_dis and η_ITdis data allow a reliable differentiation of energy dissipation and surface damping capacities of CRMs. Previously published rankings of edge chipping and loss tangent results were perfectly reproduced, especially by HLD_dis.     

Support system for decision making in the identification of risk for body dysmorphic disorder: A fuzzy model

PurposeTo develop a fuzzy linguistic model to quantify the level of distress of patients seeking cosmetic surgery. Body dysmorphic disorder (BDD) is a mental condition related to body image relatively common among cosmetic surgery patients; it is difficult to diagnose and is a significant cause of morbidity and mortality. Fuzzy cognitive maps are an efficient tool based on human knowledge and experience that can handle uncertainty in identifying or grading BDD symptoms and the degree of body image dissatisfaction. Individuals who seek cosmetic procedures suffer from some degree of dissatisfaction with appearance.MethodsA fuzzy model was developed to measure distress levels in cosmetic surgery patients based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnostic criterion B for BDD. We studied 288 patients of both sexes seeking abdominoplasty, rhinoplasty, or rhytidoplasty in a university hospital.ResultsPatient distress ranged from “none” to “severe” (range = 7.5–31.6; cutoff point = 18; area under the ROC curve = 0.923). There was a significant agreement between the fuzzy model and DSM-IV criterion B (kappa = 0.805; p < 0.001).ConclusionThe fuzzy model measured distress levels with good accuracy, indicating that it can be used as a screening tool in cosmetic surgery and psychiatric practice.     

某院静脉滴注药品说明书滴速限制项标注情况分析

目的为药品生产厂家制订静脉滴注药品说明书及临床输液有效管理提供依据,保证患者用药安全。方法筛选某院可用于静脉滴注的注射剂药品说明书609份,对药品成分分类、药物作用系统、滴速限制项的描述方式及滴速要求等项目进行分别统计。结果 609份药品说明书中有264份(43. 35%)标注了滴速要求,其中中药类标注率为56. 10%,西药类标注率为42. 43%;消化系统用药、呼吸系统用药、抗感染药、心血管系统用药、神经系统用药的标注率相对较高;标注内容有5种描述方式;分别总结了不同滴速要求的药品种类。结论静脉输液时合理调整滴速对用药的安全性和有效性非常重要,通过医、药、护、患共同参与,加强药品说明书的管理和学习,加上药品生产厂家对静脉滴注药品说明书的不断完善,有利于提高用药安全。     

静脉输液合理用药监控平台的建立和应用

目的：通过建立静脉输液合理用药监控平台,实时监控审方过程中的不合理医嘱,同时注重成品输液的稳定性和滴注速度的控制,最大程度上促进患者合理用药,减少不良反应。方法：监控平台会自动将滴注速度单位统一为mL·min^-1,根据成品输液稳定性不同,进行先后顺序自动排序。成品输液放置时间系统和滴速控制和监控系统可监控临床输液的使用情况。结果：成品输液出舱到病区时间平均减少15~20min;稳定时间2h、4h和6h内的成品输液执行及时率得到显著提高;输液滴注速度合理率由运行前的58.5%上升至88.8%;单季度输液不良反应量降幅高达45.7%。结论：通过建立完善的、全面的静脉输液合理用药监控平台,实现某院PIVAS静脉输液全流程的闭环监控,为我国医院PIVAS合理用药监控平台的补充和完善提供参考。     

静脉联合鞘内或脑室内注射多黏菌素对多重耐药鲍曼不动杆菌#br# 颅内感染疗效及安全性Meta分析

目的 系统评价多黏菌素静脉联合鞘内或脑室内注射对多重耐药鲍曼不动杆菌的疗效及安全性。方法 计算机检索PubMed、Embase、CNKI、VIP、万方数据库等数据库,检索时间为建库至2019年6月,筛选有关多黏菌素静脉联合鞘内或脑室内给药治疗多重耐药鲍曼不动杆菌感染的文献,采用RevMan 5.3软件对提取的数据进行Meta分析。结果 纳入7篇文献、178例患者。Meta分析结果显示,静脉联合鞘内或脑室内组的临床死亡率(OR=0.18, 95%CI：0.09~0.37, P＜0.00001)低于静脉组、细菌清除率(OR=20.40, 95%CI：5.94~70.12, P＜0.00001)高于静脉组;两组不良反应发生率无统计学差异(OR=0.60, 95%CI: 0.16~2.23, P=0.44)。结论 多黏菌素静脉联合鞘内或脑室内给药治疗多重耐药鲍曼不动杆菌颅内感染疗效优于静脉滴注,安全性无显著差异。     

肠系膜上动脉灌注化疗治疗大网膜转移癌所致肠梗阻的疗效观察

目的探讨肠系膜上动脉灌注化疗治疗大网膜转移癌所致肠梗阻的治疗效果,为临床治疗恶性肠梗阻提供参考。方法 115例因大网膜转移癌患者存在腹痛、腹胀、无排气排便伴或不伴有恶心、呕吐等肠梗阻症状、腹部增强CT明确腹膜转移结节、腹部立位X线平片证实存在肠管扩张、肠内积气伴或不伴有液平等肠梗阻表现、腹部彩色多普勒超声明确腹水情况,随机分为动脉灌注化疗组58例和对照组57例,分别行肠系膜上动脉灌注化疗和内科姑息治疗。比较两组肠梗阻缓解时间、腹水消退情况、治疗效果及患者生存时间,并观察肠系膜上动脉灌注化疗的不良反应。结果动脉灌注化疗组患者腹胀及腹痛缓解时间、恢复排气时间及恢复排便时间均显著短于对照组(t=3.22、5.60、3.81,P<0.05),肠道通畅维持时间较对照组显著延长(t=9.05,P<0.01),腹水改善情况(75.0%)明显较对照组(33.3%)好(χ2=11.35,P<0.01)。动脉灌注化疗组肠梗阻治疗有效率为82.8%,显著高于对照组的42.1%(χ2=14.55,P<0.01);动脉灌注化疗组生存时间(5.3±1.2)个月,较对照组的(2.8±0.9)个月显著延长(P<0.01)。动脉灌注化疗组27例(46.6%)发生腹泻,血液系统及肝肾功能损害较小。结论采用肠系膜上动脉灌注化疗治疗大网膜转移癌所致肠梗阻疗效较好,能够在短期内缓解肠梗阻症状,不良反应少,可以延长患者的生存期。