Nursing in the health care system of the postmodern world: crossroads, paradoxes and complexity

Entering the postmodern world in which society is confronting crossroads, paradoxes, and complexity, the health care system is encountering a transformation more comprehensive and revolutionary than has ever been seen before. Analysis of the state of nursing vis a vis these transformations indicates that the current paradigm does not ensure the existence of the profession in the postmodern health care system. That is because of increased difficulties in consolidating the economic and quality issues into the core of nursing, and in understanding the complexity inherent in health related situations.     

TAT和GMP-140在急性心肌梗塞患者溶栓治疗中的应用价值

目的探讨急性心肌梗塞溶栓治疗中凝血酶-抗凝血酶复合物(TAT)和血小板α-颗粒膜蛋白(GMP-140)动态变化及临床应用价值.方法以健康人为正常对照组(n=48),随机选择6h内急性心肌梗塞患者48例,用150万U尿激酶进行溶栓治疗,并按临床再通标准分为再通组(n=30),未通组(n=18),分别在溶栓前、溶栓后2h、4h、24h、48h采用酶联免疫吸附双抗体夹心法测定血浆TAT和GMP-140水平,观察其动态变化.结果患者组治疗前TAT水平(14.56±1.04)μg/L、GMP-140水平(12.50±1.05)ng/ml,较正常对照组(2.15±0.89)μg/L、(8.39±1.33)ng/ml显著升高(P<0.05),治疗后2h再通组GMP-140水平达到峰值(22.17±2.05)ng/ml,4h后TAT到达峰值(46.67±5.79)μg/L(P<0.05)后逐渐下降,持续至少3天,但仍高于正常对照组.未通组二项指标持续缓慢上升,48h达到峰值.结论急性心肌梗塞溶栓治疗前后TAT、GMP-140水平变化对判断疗效有一定指导意义.     

基于脑电复杂度的意识任务的特征提取与分类

本研究提出了利用事件相关脑电复杂度提取大脑运动意识特征，应用Mahalanobis距离判别式分析法，对人脑想象左右手运动任务进行分类，获得了满意的结果。对受试者想象左右手运动期间在大脑初级感觉运动皮层区记录的脑电信号采用复杂度分析方法量化了事件相关去同步（ERD）和事件相关同步（ERS）时程，结果表明EEG复杂度特征较好反映了ERD／ERS变化时程。最后对测试数据进行分类，最大分类正确率达到86．43％，通过最大分类正确率，最大信噪比，最大互信息等评价指标比较，验证了该方法的有效性，从而为大脑运动意识任务的特征提取及分类提供了新思路。     

Genetics,systems, and alcohol

Under a variety of rubrics (e.g., complexity, self-constructing systems, dissipative structures), interest has recently burgeoned in applying principles of complex systems to a wide variety of scientific issues. A major concern is with emergent properties of systems not derivable from the properties of components of the systems. In this paper, some elementary aspects of systems considerations are applied to phenomena of alcohol pharmacogenetics. It is likely that whole new families of informative phenotypes can be generated by this approach.     

Cost of Aseptic Revision Total Knee Arthroplasty at a Tertiary Medical Center

BackgroundRevision total knee arthroplasty (TKA) involves varying levels of case complexity and costs depending on the following: (1) number of components revised, (2) duration of operating room time, and (3) length of hospital stay. However, the cost associated with different types of aseptic TKA revisions, based on number and type of components revised, is not well described. We sought to determine differences in cost associated with different revision types, and to correlate this with average national hospital and surgeon reimbursement based on current Centers for Medicare and Medicaid Services data.MethodsThis is a retrospective review of aseptic revision TKAs performed at a single tertiary referral center from 2015 to 2018. Patient demographic data, operating room time, and direct surgery and total hospital costs obtained from an internal accounting database (Enterprise Performance Systems, Inc) were collected. Patients were stratified by the components revised (polyethylene liner only, tibia only, femur only, or both femur and tibia). We hypothesized that direct surgery and total hospital costs would increase as case complexity increased from poly exchange to single-component revisions and both-component revisions.ResultsIn total, 106 patients were included (19 poly exchanges, 10 tibia-only revisions, 13 femur-only revisions, and 64 both-component revisions). Operating room time was significantly lower for poly exchange than all other groups (P < .001). Direct surgery and total hospital costs were significantly lower for poly exchange than all other groups (P < .001), and were significantly lower for tibia-only and femur-only revisions compared to both-component revisions (P < .001). Average national surgeon reimbursement by Medicare decreased as a percentage of direct surgery cost as case complexity increased from poly exchange to tibia-only, femur-only, and both-component revisions. Total hospital cost per average Diagnosis Related Group weight was lowest for single-component revisions and highest for both-component revision.ConclusionThere are significant differences in cost associated with aseptic TKA revisions based on number and type of components revised. These differences may not be accurately reflected in reimbursement, and often represent a burden to those who treat complex revisions.     

Adult congenital heart disease

Continued advances in the understanding and management of congenital heart disease (CHD) mean that over 90% of children born with CHD now survive to adulthood. This in turn results in greater numbers of adult patients presenting for medical and surgical care at non-specialist centres. A simple classification of adult congenital heart disease (ACHD) according to complexity can help clinicians to understand the implications of the specific cardiac anomaly encountered. Issues relating to the conduct of anaesthesia in ACHD patient include careful attention to euvolaemia, the preservation of sinus rhythm and cardiac output, and in complex patients, manipulating the balance between systemic and pulmonary blood flows. Additionally, effective antibiotic prophylaxis and the prevention of either excessive bleeding or thromboembolism are vitally important. It should not be forgotten that although many patients with simple or repaired cardiac lesions may be very well managed in a non-specialist unit, those with Eisenmenger’s syndrome or severe pulmonary hypertension have an extremely high risk of death in the perioperative period, and in all but life-threatening situations should always be managed within specialist centres.     

中医系统论基本原理阐释

中医系统论是中医学关于人的生命及其健康与疾病之复杂性的现代理论,是系统中医学研究的基础理论.该研究开创于1980年,核心观点是中医学关于人的复杂性的7条基本原理,即非加和原理、元整体原理、天生人原理、有机性原理、功能性原理、有序性原理、自主性原理,及所辖的90个基本论点.中医系统论冲破经典中医学的研究视野,遵循系统科学...     

脑电非线性分析监测在异丙酚靶控输注中的应用

目的:本研究采用脑电非线性分析监测技术,研究异丙酚靶控麻醉对不同脑区的作用,并探讨其临床意义。方法:选择40例择期行腹部手术的患者,随机分为异丙酚3μg/mL靶控输注组(A组)、异丙酚4μg/mL靶控输注组(B组),每组20例。麻醉方法采用全凭静脉异丙酚靶控麻醉,监测患者清醒时、诱导、术中、苏醒、出室时的脑电非线性参数—近似熵(ApEn)、关联维数(D2)和复杂度(Cx),以及血压(BP)、心率(HR)、脉搏血氧饱和度(SpO2)变化。结果:异丙酚镇静下患者各个脑区的非线性参数值均下降,差异有统计学意义(P<0.05);组内患者,术中与清醒时、苏醒相比较,ApEn、D2和Cx下降差异有统计学意义(P<0.05);A组与B组之间,同一阶段ApEn、D2、Cx下降幅度差异无统计学意义(P>0.05);异丙酚达到靶控浓度过程中脑区从额叶和顶叶区向颞叶和枕叶逐渐被抑制,停药以后脑区又从颞叶和枕叶区向额叶和顶叶逐渐恢复兴奋。结论:在麻醉的不同阶段、不同脑区监测到的脑电非线性参数不同;异丙酚3μg/mL靶控输注与异丙酚4μg/mL靶控输注,两组浓度对脑区的抑制在非线性监测下差异无统计学意义。