Predictive factors of positive online patient ratings of spine surgeons

BACKGROUND

Online physician rating websites are increasingly used by patients to evaluate their doctors. The purpose of this investigation was to evaluate factors associated with better spine surgeon ratings.

张锡纯临证应用桂枝特色浅析

张锡纯,字寿甫,河北盐山县人,清代名医,所著《医学衷中参西录》集其多年临床实践经验之大成,融汇中西为一体,辨证严谨,选药立方别具一格而疗效卓著,对药性论述尤能独辟新义,发前人之所未发,启迪后学,一直为后人称道。本文就其对桂枝的论述及应用特色,举例浅析如下,以冀能抛砖引     

Estimating the decline in excess risk of chronic obstructive pulmonary disease following quitting smoking – A systematic review based on the negative exponential model

We quantified the decline in COPD risk following quitting using the negative exponential model, as previously carried out for other smoking-related diseases. We identified 14 blocks of RRs (from 11 studies) comparing current smokers, former smokers (by time quit) and never smokers, some studies providing sex-specific blocks. Corresponding pseudo-numbers of cases and controls/at risk formed the data for model-fitting. We estimated the half-life (H, time since quit when the excess risk becomes half that for a continuing smoker) for each block, except for one where no decline with quitting was evident, and H was not estimable. For the remaining 13 blocks, goodness-of-fit to the model was generally adequate, the combined estimate of H being 13.32 (95% CI 11.86–14.96) years. There was no heterogeneity in H, overall or by various studied sources. Sensitivity analyses allowing for reverse causation or different assumed times for the final quitting period little affected the results. The model summarizes quitting data well. The estimate of 13.32 years is substantially larger than recent estimates of 4.40 years for ischaemic heart disease and 4.78 years for stroke, and also larger than the 9.93 years for lung cancer. Heterogeneity was unimportant for COPD, unlike for the other three diseases.     

Surgical training technology for cerebrovascular anastomosis

Cerebrovascular anastomosis (for example in the management of Moyamoya disease or complex aneurysms) is a rarely performed but essential procedure in neurosurgery. Because of the complexity of this technique and the infrequent clinical opportunities to maintain skills relevant to this surgery, laboratory training is important to develop a consistent and competent performance of cerebrovascular anastomosis. We reviewed the literature pertaining to the training practices surrounding cerebrovascular anastomosis in order to understand the ways in which trainees should best develop these skills. A wide variety of training methods have been described. These may be classified into five general categories, according to training materials used, being synthetic material, living animal, animal carcass, human cadaver, and computer simulation. Ideally, a novice begins training with non-biological material. After gaining sufficient dexterity, the trainee will be able to practice using biological materials followed by high fidelity models prior to actual surgery. Unfortunately, the effectiveness of each model has generally, to our knowledge, only been judged subjectively. Objective quantification methods are necessary to accelerate the acquisition of competence.