通州市医疗卫生单位消毒质量动态比较观察

对1997～2000年通州市医疗卫生单位消毒质量监测结果进行动态比较,显示消毒质量正在稳步提高,并以2000年为最佳,县级医疗卫生单位明显优于乡镇卫生院。     

0．75％罗哌卡因硬膜外麻醉用于妇产科手术的临床观察

目的 观察０．７５％罗哌卡因硬膜外用于妇产科手术的临床效果、方法 选择７２例ＡＳＡＩ－Ⅱ级妇产科手术随机分为两组．Ｉ组为０．７５％罗哌卡因组（３６例）Ⅱ组为０．５％布比卡因组（３６例）,两组均取腰１－２行硬膜外穿刺,观察两组的感觉阻滞、运动阻滞、镇痛效果及对循环呼吸的影响和不良反应,结果 两组感觉阻滞达Ｔ８的时间。切皮时ＶＡＳ评分、运动恢复时间有显著性差异（Ｐ＜０．０５）,不良反应中寒颤的发生率Ⅰ组明显比Ⅱ组少（Ｐ＜０．０５）,结论０．７５％罗哌卡因具有起效时间快,镇痛效果好,运动阻滞恢复早,对循环呼吸的影响小,神经毒性低的临床特点。     

Measuring quality and outcomes in intensive care

While quality measures are integral to the maintenance of a high standard of patient care, high-quality care remains a complicated concept to define in the context of acute care. In this article we explore how quality can be measured in the intensive care unit. Standard outcome metrics such as mortality are tangible comparators, but do not offer a comprehensive assessment of quality for the complex heterogeneity of the intensive care population. We explore the Donabedian model as a means to describe the importance of outcomes, processes, structure and environment to inform the measurement of quality. These concepts can be more abstract and difficult to measure but can provide significant insight into the culture of a unit and the resulting performance, and thus provide a more comprehensive measure of quality.     

Robotic-Assisted Total Knee Arthroplasty: An Assessment of Content,Quality, and Readability of Available Internet Resources

BackgroundThe use of robotic-assisted total knee arthroplasty (TKA) has significantly increased over the past decade. Internet content is largely unregulated and may contain inaccurate and/or misleading information about robotic TKA. Our goal was to assess the content, quality, and readability of online material regarding robotic-assisted TKA.MethodsWe conducted an internet search for the top 50 web sites from each of the 3 most popular search engines (Google, Yahoo, and Bing) using the search term robotic total knee replacement. Each web site was assessed for content, quality, and readability. Web site quality was assessed utilizing the QUality Evaluation Scoring Tool (QUEST). Readability was assessed utilizing the Simple Measure of Gobbledygook, Flesch-Kincaid Grade Level, and Flesch Reading Ease Formula scores.ResultsGeneral risks of TKA were discussed in 47.2%, while benefits were discussed in 98.6% of all web sites. Inaccurate claims occurred at a significantly higher rate in physician/community hospital sources compared to university/academic web sites (59% vs 28%, P = .045). Web sites from university/academic web sites had the highest QUEST scores, while physician/community hospital sources scored the lowest (16.1 vs 10.6, P = .01). Most web sites were written at a college reading level or higher.ConclusionPatients should be counseled on the largely unregulated nature of online information regarding robotic-assisted TKA. Physicians and hospitals should consider revising the readability of their online information to a more appropriate level in order to provide accurate, evidence-based information to allow the patient to make an informed consent decision.     

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

BackgroundArteriovenous fistulae (AVFs) may remain patent after kidney transplantation (KTx), contributing to maladaptive cardiac remodeling. The flow in AVFs is associated with the diameter of its vessels and thus with the AVF location. The main objective of this study is to assess the influence of AVF location and its patency on the self-reported quality of life (QOL) of kidney transplant recipients (KTRs) with past history of hemodialysis.MethodsTo gain clinical data, during a scheduled visit, 353 KTRs were asked to fill out an anonymous questionnaire. From this group, 284 respondents were found eligible for analysis. The outcome was defined as prevalence of symptoms and health status, measured with the Left Ventricular Dysfunction-36 (LVD-36) Questionnaire in symptomatic patients.ResultsThe hemodialysis patients (n = 243) were divided into two groups according to AVF location, i.e., DAVF – distally located AVF – (n = 174) and PAVF – proximally located AVF – (n = 69). The proportion of patients with heart failure (HF) was higher in PAVF group (24% vs. 12%, p = 0.0482). In the multivariable regression, PAVF, serum creatinine levels, and the presence of HF or coronary artery disease (CAD) remained independent predictors of lower functional capacity. Among patients with heart disease, the presence of active AVF was independently associated with worse functional outcome (higher LVD-36 scores).ConclusionsThe influence of persistent PAVF in KTRs seems to be unfavorable, especially when coexisting with CAD or HF. Abbreviations: AVF arteriovenous fistula; BMI body mass index; CAD coronary artery disease; D-AVF distally-located arteriovenous fistula; EC exercise capacity; HD hemodialysis; HF heart failure; KTx kidney transplantation; KTR kidney transplant recipient; LVD-36 Left Ventricle Disfunction – 36; LVEF left ventricle ejection fraction; LVH left ventricle hypertrophy; NYHA New York Heart Association; P-AVF proximally located arteriovenous fistula; PD peritoneal dialysis; PRO patient-reported outcomes; QOL quality of life.     

中药解郁胶囊治疗老年抑郁症的临床疗效观察

目的：观察中药解郁胶囊对老年抑郁症的临床疗效和安全性。方法：选取2020年11月至2021年12月甘肃中医药大学附属医院住院或门诊患者200例作为研究对象,按照纳入标准最终产生研究观察对象100例,健康对照组来自我院组织的年龄在60~80岁的健康体检的老年人100例。观察组中男37例,女63例,对照组中男43例,女57例。对照组采取常规治疗,观察组采取中医综合疗法治疗。对2组患者治疗前后减分情况、中医证候分析、服药及依从情况、不良反应及抑郁焦虑因子等无创性指标的影响。结果：对老年抑郁症的治疗效果主要从汉密尔顿抑郁量表减分情况及证候减分率体现,2组经过12个月中药和抗抑郁综合治疗,中医证候量表减分率（8.2±3.1）和（7.8±3.2）,比对照组的（8.8±3）与（8.4±3.6）,P值为0.001 6和0.001 3,治疗前后均有明显变化,差异有统计学意义（P<0.05）,中医证候量表减分率比较,差异有统计学意义（P<0.05）,从服药后出现的不良反应来看,中医综合观察组应明显低于对照观察组,差异有统计学意义（P<0.05）。从中医组治疗患者的依从性分析,差异有统计学意义（P<0.05）。结论：中药解郁胶囊与中医综合治疗患者治疗效果显著,依从性更佳。     

It’s the Culture!—How systemic and societal constructs impact well‐being

Pediatric anesthesiologists practice within a culture, a system, and a society. In this article, we provide an overview of the influence these have on the well‐being or the unwellness of pediatric anesthesiologists. The scope of these issues is broad and far‐reaching; thus, our goal has been to highlight those areas which would be likely to have the largest impact on well‐being if addressed fully by society, institutions, and leaders in our field. We discuss the burnout‐promoting aspects of medical education and training. We survey occupational factors, such as the high‐stake pediatric anesthesia environment, occupational health hazards, time pressure, and the reduction in physician autonomy. We then describe societal barriers, such as the marginalization of certain populations, the US system of malpractice litigation, the stigma surrounding psychiatric care, and some of the issues related to physician reimbursement in the United States. We conclude that in order to move forward, improving physician wellness must be a focus of society, of the medical system as a whole, and of individual departments and leaders in pediatric anesthesia.