Hospice Code of Ethics

The usefulness and limitations of bibliographic database software is discussed. As an excellent example of how this medium can be used, the electronic database on palliative care developed by Dr. Nathan Cherny that is available on the World Wide Web is described.     

A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma

OBJECTIVES: This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (相似文献   

Asthma medication use in pregnancy and fetal growth

BACKGROUND: Given the high prevalence of asthma in pregnancy, it is important to understand the relationship between asthma medications and fetal growth in the context of appropriate treatment. OBJECTIVE: This study examines the effect of inhaled corticosteroids, systemic corticosteroids, and beta(2)-agonists on fetal growth in 654 infants born to women with asthma compared with 303 infants born to controls without asthma. METHODS: Subjects for this prospective study were enrolled throughout North America between 1998 and 2003 and followed up by the Organization of Teratology Information Services. Incidence of small for gestational age (SGA) infants and mean birth size measures were compared among groups. RESULTS: Mean birth weight of full-term infants born to mothers who used systemic corticosteroids (3373 g) was lower than in the beta(2)-agonist group (3552 g) and controls without asthma (3540 g; P < .05) after adjustment for other risk factors. However, no differences in the incidence of SGA for weight were observed among groups. Adjusted mean birth length was slightly shorter in the systemic steroid group compared with controls (P=.02). Incidence of SGA for length and head circumference and mean head circumference did not vary among groups (P>.05). CONCLUSION: The treatment of asthma with systemic corticosteroids resulted in a deficit of about 200 g in birth weight compared with controls and exclusive beta(2)-agonist users and no increased incidence of SGA. These results suggest that asthma management with beta(2)-agonists and/or inhaled corticosteroids during pregnancy does not impair fetal growth, whereas systemic corticosteroids have a minimal effect which should be weighed against the necessity to control severe asthma.     

The influence of comorbidity on the postoperative survival in elderly (≥ 75 years old) with lung cancer

Objectives

We conducted a multi-institutional prospective observational study of elderly patients (≥?75 years-old) with resected non-small cell lung cancer. In this report, we have followed the cohorts for 2 years after surgery and examined both the influence of preoperative comorbidity [Adult Comorbidity Evaluation-27 (ACE-27) index] on the postoperative survival and the change in the Karnofsky Performance Status (KPS).

Methods

From March 2014 to April 2015, 264 patients were prospectively registered from 22 hospitals affiliated with the National Hospital Organization. The mean age at the time of surgery was 79.3 years (range 75–90 years), and 41% of the patients were ≥?80 years of age. A total of 26% underwent sublobar resection. The study endpoints were the postoperative overall survival (OS), its prognostic factors, and the changes in the postoperative KPS.

Results

The 2-year OS was 85.3% (95% confidence interval 80.4–89.1%). Male gender, age?≥?80, a smoking history, grade 2 of ACE-27, and an advanced disease stage were significantly poor prognostic factors for the OS in the univariate risk analysis. The multivariate analysis showed that male gender, age?≥?80, an advanced disease stage and sublobar resection were significantly poor prognostic factors for the OS. In comparison with the preoperative KPS, no marked decline was observed in the postoperative chorological change of KPS.

Conclusions

In the surgical treatment of elderly patients, the comorbidity as assessed by the ACE-27 index might affect the postoperative survival, and therefore should be taken into accounts in the preoperative evaluation of the surgical indications.

     

被动操与主被动操对儿童早期发展的影响

目的研究婴儿被动操与主被动操对儿童早期发展的影响。方法将自生后2个月起在儿保门诊进行检查的80名的婴儿随机分为实验组和对照组。实验组由儿保医生指导家长每日在家中训练,对照组仅给予常规的系统管理服务。记录两组儿童4、6、9、12个月时的生长发育指标,并于生后6、9、12个月用《0—6岁发育筛查测验》(DST)进行智力测试。结果对两组婴儿4、6、9、12个月时的体重、身长发育均值进行比较,仅6月龄时身长无差异(P>0.05),其余数据有显著性差异(P<0.05):DQ和MI比较,具有显著性差异(P<0.01);两组婴儿运动能力及社会适应能力比较存在明显差别。结论被动操与主被动操对婴儿的生长发育有促进作用。     

Clinical characteristics of acute ischemic syndrome in China

目的：研究分析中国地区急性心肌缺血综合征病人的临床特点和治疗现状。方法：此项研究为国际多中心关于急性心肌缺血综合征登记经验（OASIS）的一部分。采用填写加拿大心血管合作协会统一设计的病例记录表（CRF）的方法,自1999年4月开始,收集了各中心因急性心肌缺血入院病人的资料,记录了病人主要临床特征和院内事件。结果：共注册急性心肌缺血综合征（包括不稳定心绞痛及非Q波心肌梗死）病人1509例,来自全国范围内34所医院。病人平均年龄62.3岁,其中男性62.2％,就诊时持续胸痛47.8％,心电图异常89.5％,入院诊断不稳定心绞痛91.3％,非Q波心肌梗死8.7％。住院期间溶栓3.3％,冠状动脉造影35.0％,经皮冠状动脉腔内成形术（PTCA）16.8％,冠状动脉旁路移植术（CABG）4.1％,应用硝酸酯制剂96.8％,抗血小板治疗95.5％。院内发生重要并发症18.8％,其中死亡1.2％,主要原因为严重心律失常或猝死。结论：中国地区急性心肌缺血病人以不稳定心绞痛就诊居多。我国病人住院期间PTCA治疗率相对较高,CABG治疗率较低。院内死亡最主要的原因为严重心律失常或猝死。