Surgical Technique Notes of Arterial Vascular Reconstruction During Kidney Transplantation: Personal Experience and Literature Review

Background

Arterial vascular anomalies in patients undergoing kidney transplantation (KT) are correlated with a higher incidence of early surgical complications, potentially causing graft loss. Arterial reconstruction allows patients to overcome these surgical challenges, thus minimizing the risk of poor outcomes. The aim of the present study is to retrospectively investigate the safety and effectiveness of the multiple arterial reconstruction technique with a Teflon patch in case of an unavailable aortic patch: to do so, surgical complications, graft function, and patient survival were evaluated.

Surgical innovation in LMICs–The perspective from India

Surgical Innovations are central to surgical progress, and have led to exponential growth in various fields of Surgery. Surgical Innovations in Lower and Middle Income Countries are the result of creativity of frontline health workers in search of simple, safe and ethical solutions for their unique challenges. The key lies in: ‘simplifying the idea/technique/device’ to find patients' needs-driven low-cost innovative surgical solutions; which can be used on a wider scale to achieve health equity for underserved populations. Local surgeons understand the difficulties and nuances of various problems and can provide local-evidence-based customized solutions for their patients' health problems. We developed a Surgical Innovation Ecosystem allowing us to see difficulties as opportunities, learn from everyone and conduct research on what is ‘important’ rather than what is ‘interesting’. Barriers to Surgical Innovations in Lower and Middle Income Countries are well known; however, a roadmap to overcome these barriers is now available. The right balance has to be found between encouraging creativity and innovation while maintaining ethical awareness and responsibility to patients. Introduction and adoption of Surgical Innovations are governed by evidence-based principles and have to undergo a rigorous and scientific evaluation. Science of Surgical Innovations has finally come of age and is getting its due recognition and the pioneering innovators are receiving the much needed appreciation and support.     

Relación entre exposición a riesgos psicosociales y salud: un estudio de cohorte mediante el COPSOQ-Istas21

ObjectiveTo estimate the prospective relationships between exposure to psychosocial risks dimensions included in the COPSOQ-Istas21 and the deterioration of general and mental health and sleep problems among workers residing in Spain.MethodCohort whose baseline corresponds to the 2016 Psychosocial Risks Survey with a new measurement after one year.ResultsSocial capital and interpersonal relations and leadership dimensions, as well as work?life conflict, were related to all health variables. Dimensions of work organization and job contents did it especially with the mental health, the quantitative demands with the general health and the emotional ones with the mental health. The dimensions related to job insecurity did not show relationships with health.ConclusionsThe results obtained reinforce the role of the COPSOQ-Istas21 as a useful instrument for the evaluation and prevention of psychosocial risks at work.     

责任制整体护理在结直肠外科病房的实现

目的：探讨责任制整体护理在结直肠外科病房的实施的可能性及实施效果。方法：总结责任制整体护理在某三级甲等医院结直肠外科病房的试验实施方案，调查执行该护理模式前后出院患者的满意程度和临床护理质量，并进行统计学分析。结果：试验执行责任制整体护理后，患者对临床护理的满意程度大幅提高，科室的临床护理质量也有显著提升，但是在护理文件整理方面仍有待调整。结论：责任制整体护理模式在结直肠外科病房可以实现，且能提高患者的满意程度和护理质量，深入实施后，能为患者提供更优质的临床护理服务。     

基于剂量组学预测肺癌患者放射性肺炎发生的研究

目的 探讨剂量组学在预测肺癌根治性放疗患者放射性肺炎发生中的应用潜能。方法 回顾性收集行根治性放疗的314例肺癌患者的临床资料、放疗剂量文件、定位及随访CT图像,根据临床资料及影像学随访资料对放射性肺炎进行分级,提取全肺的剂量组学特征,构建机器学习模型。应用1000次自助抽样法（bootstrap）的最小绝对值收敛和选择算子嵌套逻辑回归（LASSO‐LR）及1000次bootstrap的赤池信息量准则（AIC）向后法筛选与放射性肺炎相关的剂量组学特征,随机按照7∶3划分为训练集及验证集,应用逻辑回归建立预测模型,并应用ROC曲线及校正曲线评价模型的性能。结果 共提取120个剂量组学特征,经LASSO‐LR降维筛选得到12个特征进入“特征池”,再经过AIC向后法筛选,最终筛选出6个剂量组学特征进行模型构建,训练集AUC为0.77（95%CI为0.65~0.87）,独立验证集AUC为0.72（95%CI为0.64~0.81）。结论 利用剂量组学建立的预测模型具有预测放射性肺炎发生的潜力,但仍需继续纳入多中心数据及前瞻性数据进一步挖掘剂量组学的应用潜能。     

Using business/law negotiation techniques in response to a ‘difficult’ family

Effective communication between clinicians, patients, and families at end of life is associated with better clinical outcomes. A large body of literature describes the key skills needed for effective communication. We believe that clinicians could also benefit from communication skills more commonly associated with business or law negotiations. We will demonstrate via analogy (i.e. buying a house) how four key business/law negotiation techniques – 1. Determine your Reservation and Aspiration Value; 2. Separate People from their Positions; 3. Separate Positions from Interests; and 4. Logrolling of Interests – can be applied to a difficult family meeting in a home hospice patient.     

中西医结合治疗动眼神经麻痹疗效观察

目的了解中西医结合法治疗动眼神经麻痹的临床疗效。方法对我院2012-03—2014-03收治的动眼神经麻痹患者进行抽样,择取74例患者随机分成2组,对照组予以基础性西医疗法,实验组在对照组治疗基础上予以中医疗法(包括针刺及服用中药正容汤等),观察2组患者的临床治疗效果。结果实验组总有效率(94.60%)明显高于对照组(64.86%),差异具有统计学意义(P0.05)。结论中西医结合法治疗动眼神经麻痹临床疗效确切,安全系数高,值得临床大力推广使用。