俯卧位通气在ARDS中的临床应用价值探讨

目的探讨俯卧位通气（PPV）在急性呼吸窘迫综合征（ARDS）的临床应用价值。方法选取2006—05—2011—05江苏泗洪分金亭医院ICU收治的36例急性呼吸窘迫综合征患者．随机分为仰卧位组和俯卧位通气,两组均采用肺保护性通气策略,分别监测两组患者在充分镇静情况下初始仰卧位及俯卧位通气1h、2h、4h、6h后患者的动脉血氧分压（Pa02）、氧合指数（PaO。／Fi02）、pH值、动脉血二氧化碳分压（PaC02）、Sp02、心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）等呼吸循环指标。结果俯卧位组在动脉血氧分压（PaOz）、氧合指数（PaO2／FiO2）、SpO2等呼吸指标方面较对照组明显改善（P〈0．05）,机械通气时间、住院时间和住院期问死亡率明显降低（P〈0．05）。而心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）等循环指标较对照组无明显差异（P〉0．05）。结论俯卧位通气可明显改善ARDS患者的氧合状况,而对血流动力学影响不明显。     

油酸致大鼠急性呼吸窘迫综合征氧化应激反应和纳洛酮的拮抗作用

目的探讨纳洛酮对油酸所致大鼠急性呼吸窘迫综合征治疗作用的可能机制。方法将30只健康的Wist—ar大鼠随机分为对照组、油酸组、纳洛酮组。由股静脉注入油酸0．1ml／kg建立ARDS模型,测定肺组织MDA、SOD含量,并计算左肺湿／干重比值．行肺组织病理学及超微结构观察。结果油酸组与对照组比较,左肺湿／干重比值、肺组织中MDA含量明显升高,SOD活性明显降低,肺组织出现明显病理损害,纳洛酮组动物肺损伤轻于油酸组。结论纳洛酮可抑制MDA升高．提高SOD活性．对实验性大鼠油酸型急性呼吸窘迫综合征有一定的治疗作用。     

Predictors of survival among preterm neonates admitted to Debre Tabor Comprehensive Specialized Hospital,Northwest Ethiopia; Implication for the maternal and neonatal health care-services

IntroductionPreterm neonatal death is one of the world's most pressing problems, especially in Ethiopia, despite the implementation of extensive prevention initiatives. As a result, the goal of the study was to determine the incidence of neonatal mortality among preterm neonatal admissions in the hospital setting.MethodsThe study was conducted among preterm neonatal admissions at Debre Tabor Comprehensive Specialized Hospital from January 1, 2014, to December 30, 2017. Cox regression model was used for analysis. Variables with a p-value of 0.2 in the log-rank test were taken to multivariable cox regression analysis and level of statistical significance was declared at P- value ≤ 0.05.ResultsAccording to current study, the overall rate of premature death was 31.2 per 100 live births (95% CI: 27.3, 35.1). Males ((Adjusted Hazard Ratio (AHR) = 1.38; 95% CI: 1.01, 1.90), neonates under 32 weeks of gestational age (AHR = 1.74; 95% CI: 1.24, 2.46), neonate born from preeclampsia mothers (AHR = 1.95; 95% CI: 1.13, 3.36), neonate with extremely very low birth weight (AHR = 2.94; 95%CI: 1.05, 8.24), and neonate having respiratory distress syndrome (AHR = 1.70; 95% CI: 1.20, 2.41) were significantly associated with preterm mortality.ConclusionThe burden of preterm mortality at hospital setting was high. As a result, reducing and treating preeclampsia is critical in lowering neonatal mortality. In addition, very low birth weight newborns and premature neonates with respiratory distress syndrome should be given special attention. Considering of every premature neonates as a danger of death, essential care such as; kangaroo mother care, feeding, infection prevention, oxygen therapy, thermal care, close follow-up, and medication administration should be considered.     

Depression and diabetes distress in patients with diabetes

We aimed to identify the prevalence of comorbid depression, diabetes, and diabetes distress and assess glycemic control and rates of diabetes-related complications. While the presence of either depression or distress did not predict the level of glycemic control, certain macro- and microvascular complications were more prevalent with depression.     

Technical Update No. 433: eHealth Solutions for Urinary Incontinence Among Women

ObjectiveThe purpose of this technical update is to establish the state of the science regarding emerging and novel electronic health (eHealth) and mobile health (mHealth) solutions for urinary incontinence among women.Target populationWomen over 18 years with urinary incontinence.OptionsWebsites and mobile health applications are useful in the conservative care of urinary incontinence. Relevant care providers should be familiar with such tools, particularly those that use motivational principles for behaviour change, which can be used as adjunct tools for urinary incontinence care. Telemedicine is an effect mode to provide services for the conservative care of urinary incontinence.OutcomesUse of eHealth and mHealth solutions has potentially significant health outcomes for patients, providers, and global health systems. Broader use of telemedicine, in and of itself, could improve care access and reduce costs incurred by patients and the health care system.Benefits, Harms, and CostsEvidence for the efficacy of eHealth and mHealth technologies and applications for urinary incontinence ranges from weak to strong. However, the research landscape for many of these novel solutions is developing rapidly. Furthermore, these options have minimal or no harm and confer an established cost benefit and care access benefit.EvidenceThe Cochrane Library, Medline, EMBASE, CENTRAL databases (from January 2014 to April 2019) were searched to find articles related to conservative care of urinary incontinence in women (over 18 years) and studies on eHealth and mHealth interventions for urinary incontinence. Articles were appraised, and the collective evidence was graded.Validation methodsThe authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).Intended audienceRelevant primary care providers and medical specialists, including physicians, nurses, midwives, and pelvic health physiotherapists.SUMMARY STATEMENTS

• 1.Electronic and mobile health interventions for urinary incontinence are growing, both in their availability in the health care market and in the science to support their use (moderate).
• 2.Electronic health interventions offered in conjunction with pelvic floor muscle training, either self-directed or directed by a health care provider (physiotherapist), may provide a marginal benefit in symptom improvement for stress urinary incontinence among women (low).
• 3.Application- and web-based programming for urinary incontinence should include traditional components of self-management programs, including motivational strategies to support behavioural interventions (high).
• 4.Bladder diaries are the most studied electronic health tool for overactive bladder and urge urinary incontinence. The acceptability and feasibility of these mobile health solutions has been established (low).
• 5.There is limited research on how electronic health interventions improve urge urinary incontinence and overactive bladder (low).
• 6.Telehealth can be an effective platform for patient education and counselling on conservative and surgical management of uncomplicated stress urinary incontinence (high).

RECOMMENDATIONS

• 1.Mobile health solutions, such as applications that incorporate evidence-based, motivational, behavioural intervention principles, should be recommended to women with stress urinary incontinence if tailored in-person care is not available or accessible (strong, high).
• 2.There is currently insufficient evidence to recommend the routine use of electronic health interventions that include a physical device to improve stress urinary incontinence symptoms (conditional, very low).
• 3.Electronic health interventions may be recommended to complement stress urinary incontinence treatment, but providers should familiarize themselves with the specific interventions recommended, since they vary significantly in terms of composition, cost, and benefit (conditional, very low).
• 4.Health care providers remain the key knowledge translators and advisors on overactive bladder and urge urinary incontinence; they should not assume that patients will get the information they need from a website (strong, moderate).
• 5.Health care providers may recommend web-based self-management programs that incorporate evidence-based motivational behavioural intervention principles if tailored in-person care is not available or accessible to patients (strong, low).
• 6.Application-based bladder diaries may be used as an alternative to traditional bladder diaries as a self-monitoring tool (conditional, low).
• 7.Follow-up visits for uncomplicated stress urinary incontinence may be considered in women who are comfortable with this platform (strong, low).
• 8.Although there is insufficient evidence to recommend virtual or telehealth consultation for routine pessary care instructions, these platforms can be considered on a case-by-case basis depending on the patient’s comfort with pessary self-care (conditional, very low).
• 9.Surgical counselling for stress urinary incontinence via telehealth or virtual platforms may be considered for women who are comfortable with shared decision-making on these platforms (strong, moderate).
• 10.Post-operative virtual visits may be offered as an alternative to in-person visits after uncomplicated surgery for stress urinary incontinence (strong, moderate).