某地共用采血针引起突发公共卫生事件的调查与处理

目的通过对共用采血针引起的一起突发公共卫生事件的调查处理,交流对处置特殊突发公共卫生事件的思路与方法。方法采用现场流行病学调查、血清学检测、暴露后防护指导及宣传教育进行调查与处置。结果通过对共用采血针可能暴露于血源性病原体的学生76人的追踪观察,经过一个最长潜伏期未发现被感染个例。结论锐器伤害后必须迅速确定追踪观察时间、追踪观察内容和感染情况并及时采取筛查、应急干预、追踪观察、宣传教育等措施。     

信息共享在护理领域的应用进展

综述了信息共享的概念及相关的理论模型,阐述其在临床护理实践、疾病延续护理、护理教学和培训中的应用情况,并对护理信息共享建设提出建议和展望。     

Predictors of low risk for dropout from the liver transplant waiting list for hepatocellular carcinoma in long wait time regions: Implications for organ allocation

All patients with hepatocellular carcinoma meeting United Network for Organ Sharing T2 criteria currently receive the same listing priority for liver transplant (LT). A previous study from our center identified a subgroup with a very low risk of waitlist dropout who may not derive immediate LT benefit. To evaluate this issue at a national level, we analyzed within the United Network for Organ Sharing database 2052 patients with T2 hepatocellular carcinoma receiving priority listing from 2011 to 2014 in long wait time regions 1, 5, and 9. Probabilities of waitlist dropout were 18.3% at 1 year and 27% at 2 years. In multivariate analysis, factors associated with a lower risk of waitlist dropout included Model for End‐Stage Liver Disease‐Na < 15, Child's class A, single 2‐ to 3‐cm lesion, and α‐fetoprotein ≤20 ng/mL. The subgroup of 245 (11.9%) patients meeting these 4 criteria at LT listing had a 1‐year probability of dropout of 5.5% vs 20% for all others (P < .001). On explant, the low dropout risk group was more likely to have complete tumor necrosis (35.5% vs 24.9%, P = .01) and less likely to exceed Milan criteria (9.9% vs 17.7%, P = .03). We identified a subgroup with a low risk of waitlist dropout who should not receive the same LT listing priority.     

Outcomes of heart transplantation in patients with human immunodeficiency virus

Human immunodeficiency virus–positive (HIV+) patients are not routinely offered heart transplantation (HT) due to lack of adequate outcomes data. Between January 2004 and March 2017, we identified 41 adult (≥18 years) HT recipients with known HIV+ serostatus at the time of transplant in UNOS and evaluated post‐HT outcomes. Overall, Kaplan‐Meier (KM) estimates of survival at 1 and 5 years were 85.9% and 77.3%, respectively, with no significant difference in bridge‐to‐transplant ventricular‐assist device (BTT‐VAD, n = 22) and no‐BTT‐VAD (n = 19). KM estimates of cardiac allograft vasculopathy (CAV) and malignancy at 5 years were 32% and 19%, respectively. Using propensity scores, 41 HIV+ HT recipients were matched to 41 HIV‐ HT recipients for idiopathic dilated‐cardiomyopathy; and there was no significant difference in post‐HT survival up to 5 years. Furthermore, only 24 centers in the United States had performed HIV+ HT during the study period, indicating that >80% of HT centers in the United States had not performed any HIV+ HT. In a cohort representative of the current status of HIV+ HTs in the United States, we found that the posttransplant survival was excellent and rates of CAV and malignancy were comparable to the overall HT population. These results should encourage greater number of centers to offer HT to suitable HIV+ candidates and help reduce unequal access to HT for HIV+ patients.     

Frequency of whole‐organ in lieu of split‐liver transplantation over the last decade: Children experienced increased wait time and death

Organ shortage is a barrier to liver transplantation (LT). Split LT (SLT) increases organ utilization, saving 2 recipients. A simulation of Organ Procurement and Transplantation Network/United Network for Organ Sharing data (2007‐2017) was performed to identify whole‐organ LT grafts (WLT) that met the criteria for being splittable to 2 recipients. Waitlist consequences presented. Deceased donor (DD) livers transplanted as whole organs were evaluated for suitability to split. Of these DD organs, we identified the adolescent and adult recipients of WLT who were suitable for SLT. Pediatric candidates suitable to share the SLT were ascertained from DD match‐run lists, and 1342 splittable DD organs were identified; 438 WLT recipients met the criteria for accepting a SLT. Review of the 438 DD match‐run lists identified 420 children next on the list suitable for SLT. Three hundred thirty‐three children (79%) underwent LT, but had longer wait‐times compared to 591 actual pediatric SLT recipients (median 147 days vs 44 days, P  < 0.001). Thirty‐three of 420 children died on waitlist after a mean 206 days (standard deviation 317). Sharing organs suitable for splitting increases the number of LT, saving more lives. With careful patient selection, SLT will not be a disadvantage to the adult recipients. With a children‐first allocation scheme, SLT will naturally increase the number of allografts because adult organs are too large for small children.     

数字化整形外科多种格式资料的多站点协同共享与应用研究

为比较整形外科专科资料管理与应用系统单机版和网络版的性能差别,选择数据存储与下载时间、任务完成时间、系统稳定性与安全性指标和资料二次使用率指标,对两个系统进行测试。结果显示,在系统工作效率、安全性与稳定性,以及资料二次利用率方面,网络版得到显著提高,两者存在显著性差异（P=0．000）。通过应用网络版整形外科专科资料管理与应用系统,实现了整形外科多种格式资料的协同与共享,信息一经录入,即多点共享,显著提高了科室的工作效率及患者的随访率和满意度。     

进食共享照护计划在肠癌患者照顾中的应用效果

目的 探讨进食共享照护计划在肠癌患者照顾中的应用效果.方法 选取医院2018年3月—2019年3月收治的肠癌患者32例为研究对象,采用入院档案抽签结合组间基本特征匹配的方法将其分为观察组和对照组,各16例.对照组给予常规护理干预,观察组在此基础上给予进食共享照护计划干预,比较两组患者的照护者照护能力、营养状况及生存质量...     

Factors Associated with Survival of Patients With Severe Acute-On-Chronic Liver Failure Before and After Liver Transplantation

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In the Era of Direct-Acting Antivirals,Liver Transplant Delisting Due to Clinical Improvement for Hepatitis C Remains Infrequent

Background / AimsStudies have suggested marked increases in transplant delisting due to clinical improvement for patients with hepatitis C virus (HCV) associated cirrhosis in the era of direct acting antivirals (DAAs). This study provides a ‘real world’ assessment of waitlist dynamics for HCV transplant candidates in the current era.MethodsThis was a retrospective cohort study of adults waitlisted for liver transplant (LT) alone between 1/1/2005-12/31/2018 using national US data. The post-DAA era included all listings occurring after 1/1/2013. Temporal trends in waitlisting, patient characteristics and outcomes with decompensated cirrhosis were evaluated. Adjusted competing risks models assessed the interaction of DAA-era and HCV history on (i) waitlist mortality, and (ii) delisting due to clinical improvement.ResultsOverall listing rates for HCV patients have decreased in the DAA era and particularly with Model for End-stage Liver Disease score ≥15 and ≥30. Rates of refractory ascites and severe encephalopathy at listing have increased. Delisting due to clinical improvement remains low (6.1% for 2013-2017 versus 5.2% for 2009-2012 versus 4% for 2005-2008; p < .001) and, for many, ascites (46.5%) and encephalopathy (30.5%) persist at delisting. Waitlist recovery is more frequent for HCV patients post-DAA (adjusted SHR 1.78 vs pre-DAA, 95% CI: 1.58-2.02; p < .001), while improvements in waitlist mortality by era are similar to non-HCV candidates (adjusted SHR 0.74 [95% CI: 0.7-0.78; p < .001] and 0.77 [95% CI: 0.74-0.8; p < .001], respectively).ConclusionListing rates for decompensated HCV cirrhosis have decreased in the DAA era. Delisting of HCV patients for clinical improvement has increased, but remains infrequent and many continue to experience considerable morbidity.