Serum digoxin and beta-methyldigoxin in elderly patients on hospital admission: correlation with home compliance and clinical variables

Summary Serum digoxin and beta-methyldigoxin (BMD) were measured in 165 elderly patients (age >60 years) admitted to hospital, of whom 109 had been treated at home with digoxin and 56 with BMD.The mean BMD level was significantly lower than that of digoxin (1.1 vs. 1.4 ng/ml). Creatinine clearance and daily dose were the variables most strongly associated with digoxin level, and the prescribed dose and serum albumin were the best predictors of the BMD concentration. Compliance was assessed by a compliance index (CI), namely the ratio of the measured glycoside concentration, corrected for creatinine clearance, over the expected steady-state dose, calculated from a hospitalized reference group. Compliant individuals in both treatment groups, i.e. those with a CI > the median value, were characterized by a lower daily dose and dosage frequency.Toxicity, whether clinical or electrocardiographic, was present in 9% of the patients and was associated only with a significantly higher mean serum level of the drug.     

婴幼儿患者手术的护理要点

目的进一步认识婴幼儿患者实施外科手术的危险性及规范手术配合程序的重要性,提高配合质量,提出手术配合要点。方法回顾近几年168例婴幼儿患者外科手术护理配合,同时结合自己的临床实际经验和手术配合中的体会,提炼出婴幼儿患者手术的护理配合要点。结果婴幼儿患者手术的配合要做好术前评估,掌握患者心肺主要脏器的功能情况,做好充分准备,手术室感染控制,术中的各项检测,监测输液量、速度及体温维持情况。结论掌握婴幼儿患者手术的护理配合要点,可提高手术配合质量和手术成功率。     

Biological characteristics of newly diagnosed poor prognosis acute myelogenous leukemia

A pilot study was conducted of the biological characteristics of the leukemia cells of newly diagnosed patients with poor prognosis acute myelogenous leukemia (AML). This study included measurements of the pretherapy proliferative rate of the leukemia cells in vivo, assessment of differentiation in vivo during remission induction therapy, and the level of expression of the fms, myc, and IL1β genes in pretherapy leukemia cells. Short cell cycle times were characteristic of the best prognostic category and were associated with a rapid reduction in marrow leukemia cells in cytosine arabinoside (araC)-sensitive patients. Expression of c-fms was associated with rapid reduction in marrow leukemia cells during araC therapy and with a successful treatment outcome. Expression of the IL1β gene was associated with short remissions. These studies suggest that when compared to newly diagnosed standard prognosis AML, the leukemia of poor prognosis patients is more likely to exhibit long cell cycle times, low levels of fms expression, and is less likely to be associated with myeloid differentiation during remission induction therapy. © 1993 Wiley-Liss, Inc.     

Artificial nutrition support in intensive care units in Spain

Objective A multicenter survey to study the use of nutritional support in patients admitted to the ICU in Spain.Design The survey was announced during the annual Spanish Society of Intensive Care Medicine and Coronary Units (SEMIUC) congress meeting.Setting Questionnaires designed to determine current clinical practice concerning artificial nutrition were sent to the 27 ICU who accepted to participate.Patients and participants In each center the 235-question form was filled out individually for each patient admitted to the ICU during the month of March, 1992.Interventions To validate the study a preliminary pilot surveys were conducted to ensure that there was a correct interpretation of the questions. The replies were entered into a database for analysis.Results A total of 1261 patients were studied; 33.9% received artificial nutrition (AN). The administration of AN was significantly higher in the medical group (44%), than in the surgical (37%) and the trauma group (19%). AN was significantly lower in patients admitted to private clinic than public institutions (26.7% versus 34.7%). Among the patients who received AN, enteral nutrition (EN) was administered to 59.7% of the patients, total parenteral nutrition (TPN) to 38.5%, and peripheral parenteral nutrition (PPN) to 18.2%. Medical patients received significantly more EN than surgical and trauma patients. Surgical patients received more PN than medical and trauma groups.Conclusions Nutritional support is a common practice in the treatment of ICU patients in our country. All information concerning its use is necessary to optimize it.     

Evaluation of Mini Mental State Examination and Brief Psychiatric Rating Scale on aged schizophrenic patients

Abstract  Mini Mental State Examination (MMSE), Brief Psychiatric Rating Scale (BPRS) and subscales of the BPRS were performed on 73 elderly inpatients (mean age: 67.9 years; standard deviation: 7.2; range: 60–89) diagnosed with DSM-III-R chronic schizophrenia. Forty of the subjects were men and 33 were women. A significant negative correlation was observed between MMSE and the age, factor negative, factor depressive, and total score of BPRS. We believe, however, that it is relatively sufficient to screen for demented illness of schizophrenics using MMSE when considering the age and the psychiatric symptoms (especially negative or depressive symptoms). Forty-eight (66%) of the 73 patients were categorized as 'demented' by MMSE. These results suggest that the aged inpatients with schizophrenia in a hospital showed certain kinds of cognitive deficits (including senile dementia) more frequently than the general population.     

Phase I trial of the polyelectrolyte carbetimer administered i.v. once every four weeks

Summary Carbetimer, a new synthetic low molecular weight polyelectrolyte with a novel structure displayed antitumor activiy in a number of animal tumor model systems and in vitro investigations. Based on these findings it was brought to a phase I clinical trial in patients with advanced malignant disease after failure of conventional treatment or with no conventional treatment available. Forty-eight patients received 98 courses. The schedule was a one hour i.v. infusion every four weeks. The starting dose was 180 mg/m² and dose escalation was performed according to a modified Fibonacci formula up to 16,690 mg/m². At least three patients were treated at each dose level and each patient was eligible to receive repeat courses at the same dose, until progressive disease or dose-limiting toxicity intervened. No hematological toxicity was encountered. Some adverse effects such as reversible proteinuria, hypercalcaemia, pain at infusion site, nausea and vomiting and fatigue were seen partly in a dose-related manner but did not represent the maximum tolerated dose (MTD). The limiting toxicity at the highest dose level of 16,690 mg/m² consisted of ocular symptoms (light flashes) accompanied by a modest decrease of blood pressure and nausea or vomiting during a one hour infusion. 16,690 mg/m²/1 hour was considered the MTD. There were four deaths on study, all considered diseaserelated. Fourteen patients had stable disease for more than two courses, which, however, could also be explained by the natural course of disease. No clear-cut antitumor responses were noted in our study center.The recommended dose for phase II trials derived from our results is 12,550 mg/m²/2 hours. However, with regard to experiences in other phase I studies, the subsequent phase II studies will be performed with a dose of 6,500 mg/m².     

病房康复延伸护理对脑卒中迟缓性偏瘫患者三维步态时空参数的影响

目的:观察病房康复延伸护理对脑卒中迟缓性偏瘫患者三维步态时空参数的影响。方法:将60例脑卒中迟缓性偏瘫患者随机分为常规护理组(A组,n=30)、病房康复延伸护理组(B组,n=30)两组,予以相应的方法治疗8周,评估治疗前后两组患者三维步态时空参数。结果:与治疗前相比,治疗后两组患者的步长、步幅、步速、步频、支撑相、双支撑相等参数及B组摆动相均有不同程度的改善(P<0.05); A组摆动相和步宽及B组步宽的变化差异无统计学意义(P>0.05)。与治疗后A组比较,治疗后B组的步长、步幅、步速、步频、支撑相、双支撑相等参数改善较为明显(P<0.05),步宽和摆动相的改善差异无统计学意义(P>0.05)。结论:病房康复延伸护理能改善脑卒中迟缓性偏瘫患者三维步态时空参数,具有临床意义。     

中性粒细胞与淋巴细胞比值预测高龄卒中预后的价值

探讨中性粒细胞与淋巴细胞比值（NLR）对≥80岁急性缺血性脑卒中患者90 d预后的价值。方法 纳入2019年1月—2021年6月发病7 d内、≥80岁的缺血性卒中患者476例的相关信息、影像结果、随访结果,按照入组患者NLR的四分位数间距分为Q1组（NLR ＜2.97）、Q2组（ 2.97≤NLR ＜4.49）、Q3组（ 4.49≤NLR ＜7.94）、Q4组 （NLR≥7.94）,每组119例。根据不良结局发生率绘制K-M曲线,比较各组在不同时期的生存概率。采用Cox多因素回归分析影响患者不良预后的因素。结果log-rank检验显示,四组患者的生存率存在差异,Q4组的90 d生存率显著低于Q1组(P＜0.05)。多因素Cox回归分析显示,校正危险因素后,高NLR和高NIHSS评分是90 d死亡率的独立危险因素(P＜0.05)。根据ROC曲线,高NLR预测患者90 d死亡曲线下面积为0.74。结论 高NLR为影响≥80岁高龄急性缺血性卒中患者90 d预后的独立危险因素,对高龄急性缺血性脑卒中患者的90 d预后有预测价值     

积极、消极情感在社区老年高血压患者疾病感知与健康促进行为之间的双重中介作用

目的 探讨社区老年高血压患者疾病感知和健康促进行为的关系及积极、消极情感在两者之间的中介作用。方法 采用疾病感知问卷简化版(BIPQ)、老年人健康促进行为量表(GHP),积极、消极情感量表(PANAS)对2021年12月至2022年2月广州市3家社区卫生服务中心和1家三甲医院的高血压门诊就诊的240例老年高血压患者进行横断面调查。构建结构方程模型,并采用Bootstrap抽样法对模型进行验证。结果 社区老年高血压患者疾病感知总分为(24.74±4.45)分,健康促进行为总分为(71.78±8.70)分,积极情感总分为(20.15±3.55)分,消极情感总分为(12.16±3.11)分。相关分析显示,疾病感知、消极情感与健康促进行为呈负相关(P<0.01);积极情感与健康促进行为呈正相关(P<0.01);疾病感知与消极情感呈正相关(P<0.01),而与积极情感呈负相关(P<0.01)。双重中介结构方程模型显示：拟合优度检验(χ²/df)=1.641、近似残差均方根(RMSEA)=0.054、比较拟合指数(CFI)=0.961。积极、消极情感在...